Provider Demographics
NPI:1437246287
Name:MODAN, MOHAMMEDYUSUF (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMEDYUSUF
Middle Name:
Last Name:MODAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YUSUF
Other - Middle Name:
Other - Last Name:MODAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:97 FERNDALE DR
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1251
Mailing Address - Country:US
Mailing Address - Phone:516-242-6948
Mailing Address - Fax:
Practice Address - Street 1:12 ROSZEL RD
Practice Address - Street 2:SUITE A-103
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6234
Practice Address - Country:US
Practice Address - Phone:516-242-6948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2507022084P0802X
NJ25MA085208002084P0804X
PAMD4360032084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry