Provider Demographics
NPI:1972655355
Name:REHIM, MOHSEN (MD)
Entity Type:Individual
Prefix:
First Name:MOHSEN
Middle Name:
Last Name:REHIM
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 1:615 NEWMAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1721
Mailing Address - Country:US
Mailing Address - Phone:732-842-1122
Mailing Address - Fax:732-842-1191
Practice Address - Street 1:615 NEWMAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1721
Practice Address - Country:US
Practice Address - Phone:732-842-1122
Practice Address - Fax:732-842-1191
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0576062084P0800X
NJMA576062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5344506Medicaid
NJ5344506Medicaid
722903Medicare PIN
F18609Medicare UPIN
F18607Medicare UPIN