Provider Demographics
NPI:1174525604
Name:QURESHI, MOHAMMAD NASAR
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:NASAR
Last Name:QURESHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 COLUMBUS CIR STE A
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3907
Mailing Address - Country:US
Mailing Address - Phone:908-325-1508
Mailing Address - Fax:908-272-1478
Practice Address - Street 1:300 COLUMBUS CIR STE A
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3907
Practice Address - Country:US
Practice Address - Phone:908-325-1508
Practice Address - Fax:908-272-1478
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06546400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5098931OtherGHI PPO #
NJ57R481OtherBCBS NY #
NJ0352746000OtherAMERIHEALTH #
NJ223560900OtherTAX IDENTIFICATION #
NJ93671OtherAMERIGROUP #
NJ2K7598OtherHEALTHNET #
NJ60017468OtherHORIZON NJ HEALTH #
NJ2K7999OtherHEALTHNET #
NJP3579476OtherOXFORD #
NJ7628102Medicaid
NJ60017468OtherHORIZON NJ HEALTH #
NJ2K7999OtherHEALTHNET #