Provider Demographics
NPI:1194704585
Name:RAZA, SYED MOHSIN (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:MOHSIN
Last Name:RAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SEBER RD
Mailing Address - Street 2:DOCTORS PARK 2B
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1722
Mailing Address - Country:US
Mailing Address - Phone:908-684-0684
Mailing Address - Fax:
Practice Address - Street 1:117 SEBER RD
Practice Address - Street 2:DOCTORS PARK 2B
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1722
Practice Address - Country:US
Practice Address - Phone:908-684-0684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6673104Medicaid
NJG08270Medicare UPIN
NJ775295Medicare ID - Type Unspecified