Provider Demographics
NPI:1134162506
Name:MUFSON, ALAN S (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:S
Last Name:MUFSON
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 1:16 POCONO ROAD
Mailing Address - Street 2:SUITE 317
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834
Mailing Address - Country:US
Mailing Address - Phone:973-627-2650
Mailing Address - Fax:973-627-8383
Practice Address - Street 1:16 POCONO ROAD
Practice Address - Street 2:SUITE 317
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834
Practice Address - Country:US
Practice Address - Phone:973-627-2650
Practice Address - Fax:973-627-8383
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01791700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
32K051OtherWELLCHOICE
NJIP004OtherOXFORD
NJ0935808Medicaid
C60409Medicare UPIN
32K051OtherWELLCHOICE