Provider Demographics
NPI:1164144796
Name:HAMID, MOMIN
Entity Type:Individual
Prefix:
First Name:MOMIN
Middle Name:
Last Name:HAMID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-1136
Mailing Address - Country:US
Mailing Address - Phone:516-288-1691
Mailing Address - Fax:
Practice Address - Street 1:27 MORRISTOWN RD
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3595
Practice Address - Country:US
Practice Address - Phone:732-583-4347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04072900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist