Healthcare Provider Details

I. General information

NPI: 1689648735
Provider Name (Legal Business Name): MOHAMMAD A SARRAF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 10/26/2010
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 NumberMA30954
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: