Healthcare Provider Details

I. General information

NPI: 1316230642
Provider Name (Legal Business Name): IMRAN UL HAQ,M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WHEATLEY BLVD SUITE A
MULLICA HILL NJ
08062-9622
US

IV. Provider business mailing address

211 SHIVERS RUN CT MULLICA HILL
MULLICA HILL NJ
08062-4731
US

V. Phone/Fax

Practice location:
  • Phone: 856-558-3323
  • Fax:
Mailing address:
  • Phone: 856-558-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: IMRAN U HAQ
Title or Position: OWNER
Credential: M.D.
Phone: 856-558-3323