Provider Demographics
NPI:1598899015
Name:MOUNIR, EMAD (MD)
Entity Type:Individual
Prefix:
First Name:EMAD
Middle Name:
Last Name:MOUNIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HAMBURG TPKE STE 302
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2139
Mailing Address - Country:US
Mailing Address - Phone:973-790-9222
Mailing Address - Fax:212-562-3494
Practice Address - Street 1:401 HAMBURG TPKE STE 302
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2139
Practice Address - Country:US
Practice Address - Phone:973-790-9222
Practice Address - Fax:973-790-0671
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA065306002084P0800X
NY2184342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMO908504Medicare ID - Type Unspecified