Healthcare Provider Details

I. General information

NPI: 1366363988
Provider Name (Legal Business Name): AEVO MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 HAMBURG TPKE
WAYNE NJ
07470-4057
US

IV. Provider business mailing address

31 ARMSTRONG AVE
WAYNE NJ
07470-6358
US

V. Phone/Fax

Practice location:
  • Phone: 862-233-8200
  • Fax:
Mailing address:
  • Phone: 862-233-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAFAQ ZAMAN TARAR
Title or Position: CEO
Credential:
Phone: 862-666-0002