Provider Demographics
NPI:1306998752
Name:SYED-NAQVI, SAMINA ALTAF (MD)
Entity type:Individual
Prefix:DR
First Name:SAMINA
Middle Name:ALTAF
Last Name:SYED-NAQVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:415 AVENEL ST STE B
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1147
Mailing Address - Country:US
Mailing Address - Phone:732-634-4300
Mailing Address - Fax:732-634-4302
Practice Address - Street 1:415 AVENEL ST # B
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1147
Practice Address - Country:US
Practice Address - Phone:732-634-4300
Practice Address - Fax:732-634-4302
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07505700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0150452Medicaid