Organization Name: | WAMIQ SULTAN, INC |
NPI Number: | 1174926273 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WAMIQ SULTAN (OWNER) |
Mailing Address: | 310 Route 45 Salem |
State: | NJ US |
Postal Code: | 080792064 |
Phone Number: | 8562217169 |
Fax Number: | 8562217278 |
NPI Enumeration Date: | 10/02/2014 |
NPI Last Update Date: | 10/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 25MA06336400 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |