Healthcare Provider Details

I. General information

NPI: 1780872838
Provider Name (Legal Business Name): MOUNIR Y ABDELSHAHID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 BLOOMFIELD AVE STE K
BLOOMFIELD NJ
07003-5902
US

IV. Provider business mailing address

PO BOX 5717
CLARK NJ
07066-5717
US

V. Phone/Fax

Practice location:
  • Phone: 973-337-5993
  • Fax: 862-213-0037
Mailing address:
  • Phone: 973-337-5993
  • Fax: 862-213-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08321900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: