Provider Demographics
NPI:1760842116
Name:ATEELI, MOHAMMED
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:ATEELI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 PARK AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FAIRVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022-1116
Mailing Address - Country:US
Mailing Address - Phone:973-444-5072
Mailing Address - Fax:
Practice Address - Street 1:383 PARK AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022-1116
Practice Address - Country:US
Practice Address - Phone:973-444-5072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-27
Last Update Date:2016-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
0400580335OtherMEDICAL TRANSPORTATION