Provider Demographics
NPI:1144726308
Name:MOHIUDDIN, AMENA FATIMA
Entity type:Individual
Prefix:
First Name:AMENA
Middle Name:FATIMA
Last Name:MOHIUDDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 CRANBURY RD FL 2
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4096
Mailing Address - Country:US
Mailing Address - Phone:732-390-7750
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON BLVD STE 9
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-3162
Practice Address - Country:US
Practice Address - Phone:732-314-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA12433200207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology