Provider Demographics
NPI:1598780033
Name:ABIDI, MUTAHIR ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:MUTAHIR
Middle Name:ALI
Last Name:ABIDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:206 JACK MARTIN BLVD STE C2
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7770
Mailing Address - Country:US
Mailing Address - Phone:732-840-8402
Mailing Address - Fax:732-840-8407
Practice Address - Street 1:206 JACK MARTIN BLVD STE C2
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7770
Practice Address - Country:US
Practice Address - Phone:732-840-8402
Practice Address - Fax:732-840-8407
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07836800207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI31079Medicare UPIN
NJ091615Medicare ID - Type Unspecified