Healthcare Provider Details

I. General information

NPI: 1184831455
Provider Name (Legal Business Name): SIRAJUDDIN SHEIKH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 PENNINGTON RD SUITE 1
EWING NJ
08618-2669
US

IV. Provider business mailing address

30 PARDEE PL
EWING NJ
08628-2016
US

V. Phone/Fax

Practice location:
  • Phone: 609-890-1050
  • Fax: 609-890-0950
Mailing address:
  • Phone: 609-890-1050
  • Fax: 609-890-0950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number25MA03126100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: