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General NPI Number Information
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NPI Number | 1558472977
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Entity Type | Individual
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Provider Name | MOHAMMED NAZRUL ISLAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/24/2020
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Provider Practice Location Address
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Address Line | 243 PINE ST
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City | MOUNT HOLLY
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State | NJ
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Zip | 08060-2201
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Country | US
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Telephone | 609-267-1550
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Fax |
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Provider Business Mailing Address
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Address Line | 23 ANNAPOLIS DR
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City | MARLTON
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State | NJ
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Zip | 08053-3833
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Country | US
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Telephone | 267-779-5239
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA07918000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 25MA07918000
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License Number State | NJ
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