Healthcare Provider Details

I. General information

NPI: 1902542178
Provider Name (Legal Business Name): MINELA AVDIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FOREST AVE
PARAMUS NJ
07652-5429
US

IV. Provider business mailing address

300 FOREST AVE
PARAMUS NJ
07652-5429
US

V. Phone/Fax

Practice location:
  • Phone: 201-490-5158
  • Fax:
Mailing address:
  • Phone: 201-490-5158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number95028910
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number26NJ01300400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: