Provider Demographics
NPI:1205982667
Name:MOHR, EDWARD JAMES (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JAMES
Last Name:MOHR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:365 BROADWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2716
Mailing Address - Country:US
Mailing Address - Phone:631-789-2214
Mailing Address - Fax:631-789-2215
Practice Address - Street 1:365 BROADWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2716
Practice Address - Country:US
Practice Address - Phone:631-789-2214
Practice Address - Fax:631-789-2215
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY118285207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B12274Medicare UPIN
289301Medicare ID - Type Unspecified