Basic Information
| Provider Information | |||||||||
| NPI: | 1770511818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAHMAN | ||||||||
| FirstName: | MAHBOOB | ||||||||
| MiddleName: | U | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2697 | ||||||||
| Address2: | |||||||||
| City: | VINELAND | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083622697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567949090 | ||||||||
| FaxNumber: | 8567943058 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 PATERSON ST | ||||||||
| Address2: | ROOM/FLOOR 5200A | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322357217 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 06/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 25MA06184100 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 1013937650001 | 05 | PA | MEDICAID |