Provider Demographics
NPI:1861537094
Name:MAHMOODAH PERVEEN,MD
Entity type:Organization
Organization Name:MAHMOODAH PERVEEN,MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOODAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PERVEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-656-4539
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-0459
Mailing Address - Country:US
Mailing Address - Phone:732-202-8847
Mailing Address - Fax:732-879-0304
Practice Address - Street 1:534 AVENUE E
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3987
Practice Address - Country:US
Practice Address - Phone:201-858-8700
Practice Address - Fax:732-879-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06978000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8033803Medicaid
NJ031705Medicare ID - Type Unspecified
NJH04503Medicare UPIN