Provider Demographics
NPI:1255741617
Name:MOHAMED, AMNI
Entity type:Individual
Prefix:
First Name:AMNI
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HUDSON
Other - Middle Name:INVALID
Other - Last Name:COACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:134 EVERGREEN PL STE 409
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2010
Mailing Address - Country:US
Mailing Address - Phone:973-266-1441
Mailing Address - Fax:
Practice Address - Street 1:134 EVERGREEN PL STE 409
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2010
Practice Address - Country:US
Practice Address - Phone:973-266-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHUDS00270343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ412193592OtherTAX ID