Provider Demographics
NPI:1871523530
Name:QASIM, MAHASIN SUNA (MD)
Entity type:Individual
Prefix:
First Name:MAHASIN
Middle Name:SUNA
Last Name:QASIM
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 1:4 ETHEL RD
Mailing Address - Street 2:SUITE 405A
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2841
Mailing Address - Country:US
Mailing Address - Phone:732-339-9300
Mailing Address - Fax:732-339-9400
Practice Address - Street 1:4 ETHEL RD
Practice Address - Street 2:SUITE 405A
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2841
Practice Address - Country:US
Practice Address - Phone:732-339-9300
Practice Address - Fax:732-339-9400
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05559700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5592801Medicaid
F64989Medicare UPIN
QA127545Medicare ID - Type Unspecified