Healthcare Provider Details

I. General information

NPI: 1598899015
Provider Name (Legal Business Name): EMAD MOUNIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HAMBURG TPKE STE 302
WAYNE NJ
07470-2139
US

IV. Provider business mailing address

401 HAMBURG TPKE STE 302
WAYNE NJ
07470-2139
US

V. Phone/Fax

Practice location:
  • Phone: 973-790-9222
  • Fax: 973-790-0671
Mailing address:
  • Phone: 973-790-9222
  • Fax: 212-562-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA06530600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number218434
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: