Provider Demographics
NPI:1083090740
Name:MERCER COUNTY HEMATOLOGY & ONCOLOGY
Entity Type:Organization
Organization Name:MERCER COUNTY HEMATOLOGY & ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:WADOOD
Authorized Official - Last Name:MUGHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-394-0660
Mailing Address - Street 1:40 FULD ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-5247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 FULD ST
Practice Address - Street 2:SUITE 404
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-5247
Practice Address - Country:US
Practice Address - Phone:609-394-0660
Practice Address - Fax:609-394-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03590700207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0137341Medicaid
NJ0137341Medicaid