Healthcare Provider Details

I. General information

NPI: 1508816729
Provider Name (Legal Business Name): S MANZOOR ABIDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 ROUTE 38 E
MAPLE SHADE NJ
08052
US

IV. Provider business mailing address

504 ROUTE 38 E
MAPLE SHADE NJ
08052
US

V. Phone/Fax

Practice location:
  • Phone: 856-866-0466
  • Fax: 856-727-1483
Mailing address:
  • Phone: 856-866-0466
  • Fax: 856-727-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMA025082
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: