Provider Demographics
NPI:1659783256
Name:SANTHA MOHAN MD
Entity Type:Organization
Organization Name:SANTHA MOHAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-679-3202
Mailing Address - Street 1:16 BYRNE LN
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07640-1068
Mailing Address - Country:US
Mailing Address - Phone:201-679-3202
Mailing Address - Fax:212-831-3211
Practice Address - Street 1:335 E 118TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4253
Practice Address - Country:US
Practice Address - Phone:212-831-3210
Practice Address - Fax:212-831-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-30
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150725173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00715320Medicaid
NYB80149Medicare UPIN
NY97A911Medicare PIN