Healthcare Provider Details

I. General information

NPI: 1316881527
Provider Name (Legal Business Name): MEHRI SONGHORIAN MD MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 PARK AVE
PASSAIC NJ
07055-4455
US

IV. Provider business mailing address

284 PARK AVE
PASSAIC NJ
07055-4455
US

V. Phone/Fax

Practice location:
  • Phone: 917-862-3003
  • Fax:
Mailing address:
  • Phone: 917-862-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MEHRI SONGHORIAN
Title or Position: OWNER
Credential: MD
Phone: 917-862-3003