Healthcare Provider Details

I. General information

NPI: 1013979798
Provider Name (Legal Business Name): DEEPA S MINHAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 W MAIN ST
MENDHAM NJ
07945-1213
US

IV. Provider business mailing address

LB# 7550 PO BOX 95000
PHILADELPHIA PA
19195-7550
US

V. Phone/Fax

Practice location:
  • Phone: 973-543-1996
  • Fax: 973-543-5775
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA052535
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: