Healthcare Provider Details

I. General information

NPI: 1164336947
Provider Name (Legal Business Name): MINDBRIDGE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 US HIGHWAY 1 STE 3
EDISON NJ
08817-4433
US

IV. Provider business mailing address

485 US HIGHWAY 1 STE 3
EDISON NJ
08817-4433
US

V. Phone/Fax

Practice location:
  • Phone: 646-735-1730
  • Fax:
Mailing address:
  • Phone: 646-735-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: YAVER DURRANI
Title or Position: OWNER
Credential:
Phone: 646-735-1730