Provider Demographics
NPI:1306317094
Name:RAZZAQ, SAMIRA (NP)
Entity type:Individual
Prefix:MRS
First Name:SAMIRA
Middle Name:
Last Name:RAZZAQ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4345
Mailing Address - Country:US
Mailing Address - Phone:072-564-4644
Mailing Address - Fax:
Practice Address - Street 1:451 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3623
Practice Address - Country:US
Practice Address - Phone:201-823-3769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ008848002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00884800OtherREGISTERED NURSE PRACTITIONER