Provider Demographics
NPI:1033178355
Name:TON, MIMI NU (MD)
Entity Type:Individual
Prefix:DR
First Name:MIMI
Middle Name:NU
Last Name:TON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 W 3RD ST
Mailing Address - Street 2:APARTMENT 1419
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1782
Mailing Address - Country:US
Mailing Address - Phone:973-763-6340
Mailing Address - Fax:
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-4446
Practice Address - Fax:973-705-3148
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218892208000000X
NJ25MA080640002080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02580936Medicaid
NY02580936Medicaid
6B9001Medicare ID - Type Unspecified