Healthcare Provider Details

I. General information

NPI: 1366488306
Provider Name (Legal Business Name): MADHO K SHARMA M.D P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HOY AVE
FORDS NJ
08863-1920
US

IV. Provider business mailing address

30 HOY AVE
FORDS NJ
08863-1920
US

V. Phone/Fax

Practice location:
  • Phone: 732-225-9115
  • Fax: 732-225-2814
Mailing address:
  • Phone: 732-225-9115
  • Fax: 732-225-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMA030532
License Number StateNJ

VIII. Authorized Official

Name: DR. MADHO K SHARMA
Title or Position: OWNER
Credential: M.D
Phone: 732-225-9115