Provider Demographics
NPI:1700318946
Name:ZIADAT, MOHAMED
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:ZIADAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 E MILL RD
Mailing Address - Street 2:
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853-3118
Mailing Address - Country:US
Mailing Address - Phone:908-876-9000
Mailing Address - Fax:908-876-5578
Practice Address - Street 1:62 E MILL RD
Practice Address - Street 2:
Practice Address - City:LONG VALLEY
Practice Address - State:NJ
Practice Address - Zip Code:07853-3118
Practice Address - Country:US
Practice Address - Phone:908-876-9000
Practice Address - Fax:908-876-5578
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03788200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist