Provider Demographics
NPI:1861562662
Name:BANU, NAZIFA (MD)
Entity type:Individual
Prefix:
First Name:NAZIFA
Middle Name:
Last Name:BANU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 HAMBURG TPKE
Mailing Address - Street 2:SUITE#207
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2156
Mailing Address - Country:US
Mailing Address - Phone:973-653-3366
Mailing Address - Fax:973-653-3365
Practice Address - Street 1:246 HAMBURG TPKE
Practice Address - Street 2:SUITE#207
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2156
Practice Address - Country:US
Practice Address - Phone:973-653-3366
Practice Address - Fax:973-653-3365
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07940200207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ024092Medicaid
NJ91001928600OtherAMERICHOICE
NJ291728OtherAMERIGROUP
NJ7675342OtherCIGNA
NJ2559679OtherUNITED HEALTHCARE
NJ7685774OtherAETNA
NJCC8414OtherRAIL ROAD MEDICARE
NJJ38515OtherHEALTHNET
NJ1042675OtherHORIZON NJ HEALTH
NJ221963249OtherQUALCARE
NJP3660442OtherOXFORD
NJ7685774OtherAETNA