Provider Demographics
NPI:1053351080
Name:RAHMAN, FIROZ PUSHKIN (MD)
Entity type:Individual
Prefix:
First Name:FIROZ
Middle Name:PUSHKIN
Last Name:RAHMAN
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 1:905 HERRONTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1901
Mailing Address - Country:US
Mailing Address - Phone:814-366-1315
Mailing Address - Fax:
Practice Address - Street 1:905 HERRONTOWN RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1901
Practice Address - Country:US
Practice Address - Phone:814-366-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA070775002084P0800X
PAMD069488L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018187000009Medicaid
PA042297Medicare ID - Type Unspecified
PA0018187000009Medicaid