Provider Demographics
NPI:1275073918
Name:MUJAJ, MIRUSHA
Entity Type:Individual
Prefix:
First Name:MIRUSHA
Middle Name:
Last Name:MUJAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 COLONIAL PKWY APT 3E
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-3830
Mailing Address - Country:US
Mailing Address - Phone:914-703-0429
Mailing Address - Fax:
Practice Address - Street 1:128 COLONIAL PKWY APT 3E
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-3830
Practice Address - Country:US
Practice Address - Phone:914-703-0429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician