Individual
ISLAM MOHEISEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
89 N MAPLE AVE, RIDGEWOOD, NJ 07450-3235
(201) 797-8899
Mailing address
1400 PELHAM PKWY S, BRONX, NY 10461-1197
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22DI02829900
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/15/2020
Last updated
10/10/2023
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