Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | NJ | |
Y | 213EG0000X | General Practice | NJ |
NPI | 1003036963 |
---|---|
Provider Name | Dr. Mohit Mediratta |
First Address | Bordentown, NJ 08505-1807 |
Second Address | Bordentown, NJ 08505-1807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |