Healthcare Provider Details

I. General information

NPI: 1295803740
Provider Name (Legal Business Name): MUTAHIR ALI ABIDI MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 JACK MARTIN BLVD STE C2
BRICK NJ
08724-7770
US

IV. Provider business mailing address

495 IRON BRIDGE RD STE 5
FREEHOLD NJ
07728-5306
US

V. Phone/Fax

Practice location:
  • Phone: 732-840-8402
  • Fax: 732-840-8407
Mailing address:
  • Phone: 732-840-8402
  • Fax: 732-840-8407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMA078368
License Number StateNJ

VIII. Authorized Official

Name: DR. MUTAHIR ALI ABIDI
Title or Position: OWNER PHYSICIAN
Credential: MD
Phone: 732-840-8402