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General NPI Number Information
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NPI Number | 1306317094
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Entity Type | Individual
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Provider Name | SAMIRA RAZZAQ NP
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Gender | Female
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 451 BROADWAY
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City | BAYONNE
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State | NJ
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Zip | 07002-3623
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Country | US
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Telephone | 201-823-3769
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Fax |
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Provider Business Mailing Address
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Address Line | 27 SILVER ST
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City | BAYONNE
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State | NJ
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Zip | 07002-4345
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Country | US
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Telephone | 72-564-4644
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 26NJ00884800
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License Number State | NJ
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