Provider Demographics
NPI:1962541284
Name:RANDA FAHIM MINA LLC
Entity type:Organization
Organization Name:RANDA FAHIM MINA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RANDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:6095-874-2300
Mailing Address - Street 1:PO BOX 3007
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619
Mailing Address - Country:US
Mailing Address - Phone:609-587-2300
Mailing Address - Fax:609-587-8660
Practice Address - Street 1:2087 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3416
Practice Address - Country:US
Practice Address - Phone:609-587-2300
Practice Address - Fax:609-587-8660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2517463OtherOXFORD
40113OtherUNIVERSITY HEALTH PLAN
60019748OtherHORIZON NJ HEALTH
NJ0029726Medicaid
2517463OtherUNITED HEALTHCARE
3K2605OtherHEALTHNET