=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932364619
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIRANDA MOHABIR MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2008
-----------------------------------------------------
Last Update Date | 07/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8195 CAZENOVIA RD
-----------------------------------------------------
City | MANLIUS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13104-9631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-682-0213
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 HENRY ST
-----------------------------------------------------
City | NORWICH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13815-1302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-682-0213
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MIRANDA MOHABIR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 315-682-0213
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | 230129
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------