1942653860 NPI number — MOHAN A MENSAH DPM

Table of content: MOHAN A MENSAH DPM (NPI 1942653860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942653860 NPI number — MOHAN A MENSAH DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENSAH
Provider First Name:
MOHAN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942653860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1485 UNION VALLEY RD STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST MILFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07480-1317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-728-2211
Provider Business Mailing Address Fax Number:
610-944-8152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1485 UNION VALLEY RD STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MILFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07480-1317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-728-2211
Provider Business Practice Location Address Fax Number:
610-404-1644
Provider Enumeration Date:
07/15/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  SC006755 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1034305830 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50173588 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6536520 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7069927 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".