Provider Demographics
NPI:1154582500
Name:GHAFFAR, SADIA (MD)
Entity type:Individual
Prefix:DR
First Name:SADIA
Middle Name:
Last Name:GHAFFAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WATERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-1895
Mailing Address - Country:US
Mailing Address - Phone:856-495-8927
Mailing Address - Fax:
Practice Address - Street 1:1 WATERS EDGE DR
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-1895
Practice Address - Country:US
Practice Address - Phone:856-495-8927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09158700102L00000X, 2084P0800X, 208D00000X, 323P00000X
NJ283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0322491Medicaid