Healthcare Provider Details

I. General information

NPI: 1861521726
Provider Name (Legal Business Name): MASOOD AHMED RANGINWALA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N VAN DIEN AVE
RIDGEWOOD NJ
07450-2726
US

IV. Provider business mailing address

241 CHESTNUT AVE
BOGOTA NJ
07603-1733
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-8000
  • Fax: 201-447-8000
Mailing address:
  • Phone: 201-375-8089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MB08983800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: