Healthcare Provider Details

I. General information

NPI: 1316495245
Provider Name (Legal Business Name): MINA ESKANDAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 W FARMS RD
HOWELL NJ
07731-1215
US

IV. Provider business mailing address

522 W FARMS RD
HOWELL NJ
07731-1215
US

V. Phone/Fax

Practice location:
  • Phone: 732-701-7719
  • Fax: 732-791-1561
Mailing address:
  • Phone: 732-701-7719
  • Fax: 732-791-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: