Healthcare Provider Details

I. General information

NPI: 1942133103
Provider Name (Legal Business Name): MEGAN MOHAN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

562 KINGSLAND ST
NUTLEY NJ
07110-1069
US

IV. Provider business mailing address

79 CENTRAL AVE APT 1
MONTCLAIR NJ
07042-3040
US

V. Phone/Fax

Practice location:
  • Phone: 973-235-0101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ15586300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: