Provider Demographics
NPI:1407512205
Name:MOHAMMADI, MORSAL N (APN)
Entity Type:Individual
Prefix:
First Name:MORSAL
Middle Name:N
Last Name:MOHAMMADI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:866-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:33 OVERLOOK RD STE 201
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3562
Practice Address - Country:US
Practice Address - Phone:908-522-5045
Practice Address - Fax:908-522-5041
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1407512205363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSTUDENTMedicaid