MEDICARE: MAHASIN SUNA QASIM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	25MA05559700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871523530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHASIN SUNA QASIM M.D.

Provider Business Mailing Address
First Line	:	4 ETHEL RD
Second Line	:	SUITE 405A
City	:	EDISON
State	:	NJ
Zip	:	08817-2841
Country	:	US
Telephone Number	:	732-339-9300
Fax Number	:	732-339-9400

Provider Business Practice Location Address
First Line	:	4 ETHEL RD
Second Line	:	SUITE 405A
City	:	EDISON
State	:	NJ
Zip	:	08817-2841
Country	:	US
Telephone Number	:	732-339-9300
Fax Number	:	732-339-9400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/08/2007

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