Healthcare Provider Details

I. General information

NPI: 1700114931
Provider Name (Legal Business Name): MOHAMMAD A YOUNUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2009
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 ESSEX ST SUITE 302
HACKENSACK NJ
07601-8550
US

IV. Provider business mailing address

360 ESSEX ST SUITE 302
HACKENSACK NJ
07601-8550
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2065
  • Fax: 551-996-2169
Mailing address:
  • Phone: 551-996-2065
  • Fax: 551-996-2169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301100363
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25MA09876100
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: