Individual
DR. MATIN MIKAYIL IMANGULI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, DDS
Contact information
Practice address
102 JAMES ST STE 302, EDISON, NJ 08820-3970
(732) 635-9300
Mailing address
3600 ROUTE 66 FL 3, NEPTUNE, NJ 07753-2645
(732) 807-0877
(201) 751-1680
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401411071
VA
207Y00000X
Otolaryngology Physician
25MA10294300
NJ
207Y00000X
Otolaryngology Physician
36041
AL
207Y00000X
Otolaryngology Physician
Q0461
TX
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
25MA10294300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113660124
TAX IDENTIFICATION
VA
01
—
542034392
TAX IDENTIFICATION
VA
01
—
841629676
TAX IDENTIFICATION
VA
Enumeration date
02/01/2007
Last updated
12/12/2023
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