Provider Demographics
NPI:1770178840
Name:GARDEN STATE MOBILE MEDICINE
Entity type:Organization
Organization Name:GARDEN STATE MOBILE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ADIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZOOR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-314-7410
Mailing Address - Street 1:67 APPLE ST
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2636
Mailing Address - Country:US
Mailing Address - Phone:732-314-7410
Mailing Address - Fax:732-351-2062
Practice Address - Street 1:67 APPLE ST
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-2636
Practice Address - Country:US
Practice Address - Phone:732-314-7410
Practice Address - Fax:732-351-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty