Provider Demographics
NPI:1295803740
Name:MUTAHIR ALI ABIDI MD LLC
Entity type:Organization
Organization Name:MUTAHIR ALI ABIDI MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MUTAHIR
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:ABIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-840-8402
Mailing Address - Street 1:PO BOX 7106
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-7106
Mailing Address - Country:US
Mailing Address - Phone:732-840-8402
Mailing Address - Fax:732-840-8407
Practice Address - Street 1:24 STATE ROUTE 34 S
Practice Address - Street 2:SUITE C-2
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2415
Practice Address - Country:US
Practice Address - Phone:732-840-8402
Practice Address - Fax:732-840-8407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA078368207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty