Healthcare Provider Details

I. General information

NPI: 1568781672
Provider Name (Legal Business Name): MOHAMMAD H MIQBEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 43RD ST
UNION CITY NJ
07087-5008
US

IV. Provider business mailing address

320 43RD ST
UNION CITY NJ
07087-5008
US

V. Phone/Fax

Practice location:
  • Phone: 201-863-8032
  • Fax:
Mailing address:
  • Phone: 201-863-8032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA09344800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: