Healthcare Provider Details

I. General information

NPI: 1073601225
Provider Name (Legal Business Name): M.A. SARRAF, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 PARK AVE SUITE 202
SOUTH PLAINFIELD NJ
07080-5530
US

IV. Provider business mailing address

1907 PARK AVE SUITE 202
SOUTH PLAINFIELD NJ
07080-5530
US

V. Phone/Fax

Practice location:
  • Phone: 908-561-1313
  • Fax: 908-561-3917
Mailing address:
  • Phone: 908-561-1313
  • Fax: 908-561-3917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. MOHAMMAD A SARRAF
Title or Position: PRESIDENT
Credential: MD
Phone: 908-561-1313