Healthcare Provider Details

I. General information

NPI: 1811884414
Provider Name (Legal Business Name): MISHAEL INYA-AGHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 MILLBURN AVE
MILLBURN NJ
07041-1847
US

IV. Provider business mailing address

49 W MOUNT PLEASANT AVE UNIT 140
LIVINGSTON NJ
07039-7012
US

V. Phone/Fax

Practice location:
  • Phone: 732-520-0536
  • Fax:
Mailing address:
  • Phone: 732-520-0536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04497300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: