Provider Demographics
NPI:1508536590
Name:OOMMEN, MINI (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MINI
Middle Name:
Last Name:OOMMEN
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:MINI
Other - Middle Name:
Other - Last Name:OOMMEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:94 OLD SHORT HILLS RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5672
Mailing Address - Country:US
Mailing Address - Phone:973-322-5000
Mailing Address - Fax:
Practice Address - Street 1:94 OLD SHORT HILLS RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5672
Practice Address - Country:US
Practice Address - Phone:973-322-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01179700363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics