Healthcare Provider Details

I. General information

NPI: 1649309170
Provider Name (Legal Business Name): A F M Z HAQUE M D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SPRUCE CT
PLAINSBORO NJ
08536-2062
US

IV. Provider business mailing address

7 SPRUCE CT
PLAINSBORO NJ
08536-2062
US

V. Phone/Fax

Practice location:
  • Phone: 732-647-6000
  • Fax:
Mailing address:
  • Phone: 732-647-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA08002900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25MA08002900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: