Provider Demographics
NPI:1689635286
Name:MOHSEN, REYAD (MD)
Entity Type:Individual
Prefix:DR
First Name:REYAD
Middle Name:
Last Name:MOHSEN
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:PO BOX 4630
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07474-4630
Mailing Address - Country:US
Mailing Address - Phone:973-790-3433
Mailing Address - Fax:973-790-0433
Practice Address - Street 1:508 HAMBURG TPKE
Practice Address - Street 2:SUITE 202
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8482
Practice Address - Country:US
Practice Address - Phone:973-790-3433
Practice Address - Fax:973-790-0433
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62887207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7046707Medicaid
NJ7046707Medicaid
NJ873003Medicare ID - Type Unspecified