Provider Demographics
NPI:1639166309
Name:MOBARAKAI, NEVILLE KEKI (MD)
Entity Type:Individual
Prefix:DR
First Name:NEVILLE
Middle Name:KEKI
Last Name:MOBARAKAI
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 1:33 SUNNYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-4204
Mailing Address - Country:US
Mailing Address - Phone:908-233-3523
Mailing Address - Fax:
Practice Address - Street 1:1408 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2312
Practice Address - Country:US
Practice Address - Phone:718-979-5647
Practice Address - Fax:718-979-5650
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195536207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01696299Medicaid
NY901981Medicare ID - Type Unspecified
NY01696299Medicaid