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General NPI Number Information
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NPI Number | 1184540361
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Entity Type | Organization
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Legal Business Name | MINO MD LLC
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Dates
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Enumeration Date | 06/24/2026
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Last Update Date | 06/24/2026
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Provider Practice Location Address
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Address Line | 1 W RIDGEWOOD AVE STE 206
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City | PARAMUS
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State | NJ
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Zip | 07652-2361
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Country | US
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Telephone | 917-707-2354
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Fax |
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Provider Business Mailing Address
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Address Line | 2810 N CHURCH ST # 277990
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City | WILMINGTON
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State | DE
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Zip | 19802-4447
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | TOYA CORNELIOUS
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Credential |
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Telephone | 856-383-5101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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