Provider Demographics
NPI:1811178700
Name:NADEEM, ATIYA
Entity type:Individual
Prefix:DR
First Name:ATIYA
Middle Name:
Last Name:NADEEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 RTE 130
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3085
Mailing Address - Country:US
Mailing Address - Phone:732-658-1102
Mailing Address - Fax:
Practice Address - Street 1:1901 RTE 130
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3085
Practice Address - Country:US
Practice Address - Phone:732-658-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246099174400000X
NJ25MA08300900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ147408Medicare PIN