Healthcare Provider Details

I. General information

NPI: 1194495358
Provider Name (Legal Business Name): MAHI PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 WILSON AVE SUITE 2D
NEWARK NJ
07105
US

IV. Provider business mailing address

41 WILSON AVE SUITE 2D
NEWARK NJ
07105
US

V. Phone/Fax

Practice location:
  • Phone: 973-589-7337
  • Fax: 973-589-1905
Mailing address:
  • Phone: 973-589-7337
  • Fax: 973-589-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: UMA KANIKICHARLA
Title or Position: CEO
Credential: MD
Phone: 973-589-7337