=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710167184
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NADIA MOHSIN RAZZAK MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2007
-----------------------------------------------------
Last Update Date | 01/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 BROWERTOWN RD SUITE 001
-----------------------------------------------------
City | WOODLAND PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07424-2671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-582-0644
-----------------------------------------------------
Fax | 973-582-0605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 BROWERTOWN RD SUITE 001
-----------------------------------------------------
City | WOODLAND PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07424-2671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-582-0644
-----------------------------------------------------
Fax | 973-582-0605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 25MA08326100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------