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General NPI Number Information
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NPI Number | 1700812617
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Entity Type | Individual
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Provider Name | NAFISA Z. POONAWALA M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | RAHWAY AVENUE WOODBRIDGE DEVELOPMENTAL CENTER
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-0189
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Country | US
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Telephone | 732-499-5951
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Fax |
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Provider Business Mailing Address
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Address Line | STATE OF NJ DEPT. OF TREASURY PO BOX 15280
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City | NEWARK
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State | NJ
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Zip | 07192-0001
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Country | US
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Telephone |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 25MA04302700
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License Number State | NJ
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