Provider Demographics
NPI:1700825999
Name:MIAN, BILAL (MD)
Entity Type:Individual
Prefix:
First Name:BILAL
Middle Name:
Last Name:MIAN
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 1:310 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3006
Mailing Address - Country:US
Mailing Address - Phone:908-725-5565
Mailing Address - Fax:908-725-2219
Practice Address - Street 1:310 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-3006
Practice Address - Country:US
Practice Address - Phone:908-725-5565
Practice Address - Fax:908-725-2219
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA28968174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56119Medicare UPIN