Provider Demographics
NPI:1558555227
Name:HAZARI MUDULI, MD, LLC
Entity Type:Organization
Organization Name:HAZARI MUDULI, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JALPA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-729-2619
Mailing Address - Street 1:350 SPARTA AVE
Mailing Address - Street 2:UNIT B6B
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1150
Mailing Address - Country:US
Mailing Address - Phone:973-729-2619
Mailing Address - Fax:973-729-2604
Practice Address - Street 1:350 SPARTA AVE
Practice Address - Street 2:UNIT B6B
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1150
Practice Address - Country:US
Practice Address - Phone:973-729-2619
Practice Address - Fax:973-729-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ117395Medicare PIN