Provider Demographics
NPI:1689872012
Name:MOHAN, BRIJ (MD)
Entity Type:Individual
Prefix:
First Name:BRIJ
Middle Name:
Last Name:MOHAN
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 1:191 N LEHIGH AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3040
Mailing Address - Country:US
Mailing Address - Phone:908-644-5182
Mailing Address - Fax:908-272-0212
Practice Address - Street 1:68 HARRIS BUSHVILLE RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-3027
Practice Address - Country:US
Practice Address - Phone:845-794-0996
Practice Address - Fax:845-796-1404
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR8004208600000X
PAMD438480208600000X
NY255216-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY255216OtherNY LICENSE