Healthcare Provider Details

I. General information

NPI: 1013590777
Provider Name (Legal Business Name): MOMNA AYUB DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 STATE ROUTE 31
FLEMINGTON NJ
08822-5795
US

IV. Provider business mailing address

111 STATE ROUTE 31
FLEMINGTON NJ
08822-5795
US

V. Phone/Fax

Practice location:
  • Phone: 908-284-9880
  • Fax:
Mailing address:
  • Phone: 908-284-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB12286400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: