Healthcare Provider Details

I. General information

NPI: 1871561506
Provider Name (Legal Business Name): MOHSIN ALI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 PARK AVE
PLAINFIELD NJ
07060-3011
US

IV. Provider business mailing address

1132 PARK AVE
PLAINFIELD NJ
07060-3011
US

V. Phone/Fax

Practice location:
  • Phone: 732-494-7725
  • Fax: 732-400-6733
Mailing address:
  • Phone: 732-494-7725
  • Fax: 732-400-6733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number208483
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA06817900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8707103
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: