Healthcare Provider Details

I. General information

NPI: 1689253189
Provider Name (Legal Business Name): SHABAAZ MIRZA BAIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BERGEN ST
NEWARK NJ
07103-2496
US

IV. Provider business mailing address

150 BERGEN ST
NEWARK NJ
07103-2496
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA13101500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: