Individual
IQTIDAR MANSOOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
425 JACK MARTIN BLVD, BRICK, NJ 08724-7732
(732) 840-2200
Mailing address
159 NEWMAN AVE, BAYONNE, NJ 07002-2452
(551) 221-4990
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MA12548800
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2022
Last updated
05/30/2025
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