Healthcare Provider Details

I. General information

NPI: 1184540361
Provider Name (Legal Business Name): MINO MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W RIDGEWOOD AVE STE 206
PARAMUS NJ
07652-2361
US

IV. Provider business mailing address

2810 N CHURCH ST # 277990
WILMINGTON DE
19802-4447
US

V. Phone/Fax

Practice location:
  • Phone: 917-707-2354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TOYA CORNELIOUS
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 856-383-5101