Healthcare Provider Details

I. General information

NPI: 1649314329
Provider Name (Legal Business Name): SHABNAM MAGHSOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MANCHESTER AVE STE 201
FORKED RIVER NJ
08731-1366
US

IV. Provider business mailing address

331 NEWMAN SPRINGS RD STE 220
RED BANK NJ
07701-5792
US

V. Phone/Fax

Practice location:
  • Phone: 609-242-5041
  • Fax: 609-489-4835
Mailing address:
  • Phone: 732-807-0877
  • Fax: 201-751-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08882100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: