Provider Demographics
NPI:1982798294
Name:HUDA, RAFEUL (MD)
Entity Type:Individual
Prefix:
First Name:RAFEUL
Middle Name:
Last Name:HUDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 WILLIAMSON ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3674
Mailing Address - Country:US
Mailing Address - Phone:908-352-4579
Mailing Address - Fax:908-352-3540
Practice Address - Street 1:240 WILLIAMSON ST
Practice Address - Street 2:SUITE 506
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3674
Practice Address - Country:US
Practice Address - Phone:908-352-4579
Practice Address - Fax:908-352-3540
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03718000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0409405Medicaid
NJ442158OtherPTAN
NJ442158OtherPTAN
NJC54573Medicare UPIN