Provider Demographics
NPI:1235711946
Name:PANAH, ABDULLAH (DO)
Entity type:Individual
Prefix:
First Name:ABDULLAH
Middle Name:
Last Name:PANAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 S. WHITE HORSE PIKE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2033
Mailing Address - Country:US
Mailing Address - Phone:609-704-0185
Mailing Address - Fax:609-704-0195
Practice Address - Street 1:854 S WHITE HORSE PIKE SUITE 4
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2033
Practice Address - Country:US
Practice Address - Phone:609-704-0185
Practice Address - Fax:609-704-0195
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB12114800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine