Provider Demographics
NPI:1457331258
Name:MOHAMMADI, MINA (MD)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:
Last Name:MOHAMMADI
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 1:222 HIGH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-9604
Mailing Address - Country:US
Mailing Address - Phone:973-579-5090
Mailing Address - Fax:973-579-7409
Practice Address - Street 1:222 HIGH ST
Practice Address - Street 2:STE 102
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-9604
Practice Address - Country:US
Practice Address - Phone:973-579-5090
Practice Address - Fax:973-579-7409
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07859200207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0069221Medicaid
NJ25MA07859200Medicare ID - Type Unspecified
NJ0069221Medicaid