Provider Demographics
NPI:1194495358
Name:MAHI PEDIATRICS PC
Entity type:Organization
Organization Name:MAHI PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:UMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANIKICHARLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-589-7337
Mailing Address - Street 1:41 WILSON AVE
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105
Mailing Address - Country:US
Mailing Address - Phone:973-589-7337
Mailing Address - Fax:973-589-1905
Practice Address - Street 1:41 WILSON AVE
Practice Address - Street 2:SUITE 2D
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105
Practice Address - Country:US
Practice Address - Phone:973-589-7337
Practice Address - Fax:973-589-1905
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAHI PEDIATRICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60090050Medicaid