Healthcare Provider Details

I. General information

NPI: 1760309686
Provider Name (Legal Business Name): MBM MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 COACH DR
OCEAN NJ
07712-4145
US

IV. Provider business mailing address

901 COACH DR
OCEAN NJ
07712-4145
US

V. Phone/Fax

Practice location:
  • Phone: 732-508-0996
  • Fax:
Mailing address:
  • Phone: 732-508-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MIKE MIZRAHI
Title or Position: FOUNDER & MEDICAL DIRECTOR
Credential: D.O.
Phone: 732-508-0996