| Mim Medical Pc | |
|
11 Mackay Ave Paramus NJ 07652-1273 | |
| (201) 587-0380 | |
| (201) 587-0384 |
| Full Name | Mim Medical Pc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 11 Mackay Ave, Paramus, New Jersey |
| Authorized Official Name and Position | Marina N Metelitisin (OWNER) |
| Authorized Official Contact | 2015870380 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mim Medical Pc 13876 Queens Blvd First Floor Briarwood NY 11435-2930 Ph: (718) 850-6345 | Mim Medical Pc 11 Mackay Ave Paramus NJ 07652-1273 Ph: (201) 587-0380 |
| NPI Number | 1982875662 |
|---|---|
| Provider Enumeration Date | 03/20/2008 |
| Last Update Date | 07/13/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982875662 | NPI | - | NPPES |
| 25MA06616900 | Other | NJ | LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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