Organization
MIRAGENEX LLC
Active
Organization
MIRAGENEX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMAD A KHODAIR MD (OWNER)
(347) 669-1693
Entity
Organization
Contact information
Practice address
125 MICHAEL DR STE 106, SYOSSET, NY 11791-5311
(347) 669-1693
(516) 753-9964
Mailing address
24 LITTLE FALLS RD STE E, FAIRFIELD, NJ 07004-1913
(347) 669-1693
(516) 753-9964
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
04/28/2023
Last updated
04/28/2023
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