Healthcare Provider Details

I. General information

NPI: 1699823328
Provider Name (Legal Business Name): MAHNAZ CHAND TANTAWI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 MARKET ST SUITE 4B
SADDLE BROOK NJ
07663-5300
US

IV. Provider business mailing address

177 SUMMIT AVE
HACKENSACK NJ
07601-1311
US

V. Phone/Fax

Practice location:
  • Phone: 201-712-7900
  • Fax: 201-712-7902
Mailing address:
  • Phone: 201-983-2455
  • Fax: 201-487-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA07672700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: