Provider Demographics
NPI:1518915131
Name:MIN, DOROTHY D (MD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:D
Last Name:MIN
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 1:1261 ROUTE 38
Mailing Address - Street 2:SUITE A
Mailing Address - City:HIANESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2702
Mailing Address - Country:US
Mailing Address - Phone:856-222-1975
Mailing Address - Fax:856-222-0721
Practice Address - Street 1:1261 ROUTE 38
Practice Address - Street 2:SUITE A
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036-2702
Practice Address - Country:US
Practice Address - Phone:856-222-1975
Practice Address - Fax:856-222-0721
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA 74755207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4624807Medicaid
NJ8997209Medicaid
NJ4624807Medicaid
NJ8997209Medicaid