Healthcare Provider Details

I. General information

NPI: 1003488289
Provider Name (Legal Business Name): DR. SAAD NAZMUNNOOR ISLAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 SUMMIT AVE
HACKENSACK NJ
07601-1374
US

IV. Provider business mailing address

83 SUMMIT AVE
HACKENSACK NJ
07601-1374
US

V. Phone/Fax

Practice location:
  • Phone: 551-309-3555
  • Fax:
Mailing address:
  • Phone: 551-309-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00379700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: