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General NPI Number Information
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NPI Number | 1174926273
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Entity Type | Organization
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Legal Business Name | WAMIQ SULTAN, INC
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 310 ROUTE 45
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City | SALEM
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State | NJ
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Zip | 08079-2064
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Country | US
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Telephone | 856-221-7169
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Fax | 856-221-7278
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Provider Business Mailing Address
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Address Line | 3241 SARUM FARM LN
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City | BOOTHWYN
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State | PA
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Zip | 19060-2258
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Country | US
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Telephone | 856-221-7169
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Fax | 856-221-7278
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Authorized Official
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Title or Position | OWNER
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Name | DR. WAMIQ SULTAN
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Credential | MD
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Telephone | 856-221-7169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 25MA06336400
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License Number State | NJ
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