Provider Demographics
NPI:1144561176
Name:MAHMUDI, AVNI (DIPL OM)
Entity Type:Individual
Prefix:MR
First Name:AVNI
Middle Name:
Last Name:MAHMUDI
Suffix:
Gender:M
Credentials:DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ROGER CT
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-2418
Mailing Address - Country:US
Mailing Address - Phone:201-953-0785
Mailing Address - Fax:
Practice Address - Street 1:50 ROGER CT
Practice Address - Street 2:
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456-2418
Practice Address - Country:US
Practice Address - Phone:201-953-0785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00098100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist