Provider Demographics
NPI:1164502183
Name:ABESSI, MITRA (MD)
Entity Type:Individual
Prefix:
First Name:MITRA
Middle Name:
Last Name:ABESSI
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 1:537 US HIGHWAY 22 E
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08889-3696
Mailing Address - Country:US
Mailing Address - Phone:908-237-4155
Mailing Address - Fax:908-534-6634
Practice Address - Street 1:537 US HIGHWAY 22 E FL 3
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE STATION
Practice Address - State:NJ
Practice Address - Zip Code:08889-3696
Practice Address - Country:US
Practice Address - Phone:908-237-4155
Practice Address - Fax:908-534-6634
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08554100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02673756Medicaid
NY02673756Medicaid
NYRA7736Medicare PIN