Healthcare Provider Details

I. General information

NPI: 1588830079
Provider Name (Legal Business Name): MAINLAND PEDIATRIC ASSOC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 S 2ND AVE
GALLOWAY NJ
08205-9542
US

IV. Provider business mailing address

741 S 2ND AVE
GALLOWAY NJ
08205-9542
US

V. Phone/Fax

Practice location:
  • Phone: 609-748-8500
  • Fax:
Mailing address:
  • Phone: 609-748-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA43158
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SABAH AMIR
Title or Position: PRESIDENT
Credential: MD
Phone: 609-748-8500