Healthcare Provider Details

I. General information

NPI: 1972921898
Provider Name (Legal Business Name): MIAN NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2014
Last Update Date: 03/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E MAIN ST
SOMERVILLE NJ
08876-3006
US

IV. Provider business mailing address

310 E MAIN ST
SOMERVILLE NJ
08876-3006
US

V. Phone/Fax

Practice location:
  • Phone: 908-725-5565
  • Fax:
Mailing address:
  • Phone: 908-725-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MB08330900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number25MB08330900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number25MB08330900
License Number StateNJ

VIII. Authorized Official

Name: DR. NIMER MIAN
Title or Position: OWNER
Credential: DO
Phone: 908-963-1610