Provider Demographics
NPI:1194368795
Name:MBAH, ANDREAS NJI
Entity Type:Individual
Prefix:
First Name:ANDREAS
Middle Name:NJI
Last Name:MBAH
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 1:3404 PERIWINKLE CT APT 107
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2741
Mailing Address - Country:US
Mailing Address - Phone:347-988-6436
Mailing Address - Fax:
Practice Address - Street 1:3404 PERIWINKLE CT APT 107
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2741
Practice Address - Country:US
Practice Address - Phone:347-988-6436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-26
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDI47473207ZP0105X
NYCQP105990207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine