DR. MATIN MIKAYIL IMANGULI (NPI# 1114065406) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114065406 |
| Entity Type | Individual |
| Full Name | DR. MATIN MIKAYIL IMANGULI |
| Credential | MD, DDS |
| Practice Address |
125 Paterson St Ste 4100 New Brunswick NJ 08901-1962 |
| Practice Telephone | 7322357757 |
| Practice Fax Number | 7322357095 |
| Mailing Telephone | 7322357757 |
| Mailing Fax Number | 7322357095 |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2020-01-31 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | 0401411071 | VA | Dental Providers |
| N | 207Y00000X | Otolaryngology | 25MA10294300 | NJ | Allopathic & Osteopathic Physicians |
| N | 207Y00000X | Otolaryngology | 36041 | AL | Allopathic & Osteopathic Physicians |
| N | 207Y00000X | Otolaryngology | Q0461 | TX | Allopathic & Osteopathic Physicians |
| Y | 207YX0007X |
Otolaryngology Specialization: Plastic Surgery within the Head & Neck |
25MA10294300 | NJ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | TAX IDENTIFICATION | 113660124 | 01 |
| VA | TAX IDENTIFICATION | 841629676 | 01 |
| VA | TAX IDENTIFICATION | 542034392 | 01 |
| Street Address |
125 PATERSON ST STE 4100 |
| City | NEW BRUNSWICK |
| State | NJ |
| Zip Code | 08901-1962 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538760780 | Joanna M Gurdak | Nurse Practitioner | 125 Paterson St Ste 4100, New Brunswick, NJ 08901-1962 | 2020-11-04 |
| 1659758035 | Raymond Mirasol | Psychiatry & Neurology | 125 Paterson St Ste 4100, New Brunswick, NJ 08901-1962 | 2015-05-05 |
| 1396004677 | Emily Vankouwenberg | Plastic Surgery | 125 Paterson St Ste 4100, New Brunswick, NJ 08901 | 2012-05-08 |
| 1891936704 | Dylan Nieman | Surgery | 125 Paterson St Ste 4100, New Brunswick, NJ 08901-1962 | 2009-03-23 |
| 1376700096 | Anthony Lemaire | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 125 Paterson St Ste 4100, New Brunswick, NJ 08901-1962 | 2008-05-20 |
| 1144429663 | Lois Udo Sakorafas | Surgery | 125 Paterson St Ste 4100, New Brunswick, NJ 08901 | 2007-07-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083242622 | Daniel Kareem Haddad | Student in an Organized Health Care Education/Training Program | 1 Robert Wood Johnson Place, Meb 422a, New Brunswick, NJ 08901 | 2020-03-30 |
| 1922636588 | Neil Anjan Basumallik | Student in an Organized Health Care Education/Training Program | Rutgers Rwjms, Department of Medicine, 125 Paterson Street. Cab 7300, New Brunswick, NJ 08901 | 2020-03-30 |
| 1922636406 | Naveena Lall | Student in an Organized Health Care Education/Training Program | Rutgers Robert Wood Johnson Internal Medicine Residency, 125 Paterson Street, New Brunswick, NJ 08901 | 2020-03-30 |
| 1801444047 | Swati Vijay Dhobale | Student in an Organized Health Care Education/Training Program | Saint Peter's University Hospital, 254 Easton Avenue, 4th Floor, Cares Room 4014, New Brunswick, NJ 08901 | 2019-08-30 |
| 1962974329 | Lauren Burgstresser | Nurse Practitioner | 181 Somerset Street, 3rd Floor, New Brunswick, NJ 08901 | 2018-12-26 |
| 1851874291 | Damon House Inc. | Substance Abuse Rehabilitation Facility | 105 Joyce Kilmer Ave, New Brunswick, NJ 08901 | 2018-09-12 |
| 1245718204 | Leah Dinardo | Psychologist | 61 Nichol Ave, New Brunswick, NJ 08901 | 2018-08-01 |
| 1730667130 | Keshav Bhandari | Student in an Organized Health Care Education/Training Program | Saint Peters University Hospital, 254 Easton Avenue, 4th Floor Cares, Rm 4014, New Brunswick, NJ 08901 | 2018-07-30 |
| 1942787486 | Mehak Bassi | Student in an Organized Health Care Education/Training Program | 4th Floor Cares, Rm 4014 240 Easton Avenue, New Brunswick, NJ 08901 | 2018-07-27 |
| 1063908754 | Oluwatoba Opeyemi Moninuola | Student in an Organized Health Care Education/Training Program | 4th Floor Cares, Rm 4014, 240 Easton Avenue, New Brunswick, NJ 08901 | 2018-07-05 |
| Find all providers in zip 08901 | ||||
| Taxonomy Code | 207YX0007X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Plastic Surgery within the Head & Neck |
| An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy is currently provided in the subspecialty of Otolaryngology/Facial Plastic Surgery (see Taxonomy Code 207YX0905X) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982896890 | Philip Charles Chapalis | Otolaryngology | Dover Mall Route 37& 166, Hearing Aide Center, Toms River, NJ 08753 | 2007-08-14 |
| 1528285335 | Kevin Howard Ende | Otolaryngology | 23 West Palisade Ave, Englewood, NJ 07631 | 2007-04-20 |
| 1083831325 | Stuart A Ort | Otolaryngology | 485 Route 1 South - Suite 350, Bldg. B, 3rd Floor, Iselin, NJ 17033-2360 | 2007-04-19 |
| 1710074562 | Apostolos A. Paul Rossos | Otolaryngology | 1542 Kuser Road Suite B-5, Hamilton, NJ 08619 | 2006-10-05 |
| 1003910472 | Arvind Prabhat | Otolaryngology | 1131 Broad St Ste 103, Shrewsbury, NJ 07702-4334 | 2006-09-07 |
| 1275559890 | Antoine C Chaker | Otolaryngology | 20 Hospital Dr Ste 18, Toms River, NJ 08755-6434 | 2006-07-15 |
| 1588692149 | Ear, Nose & Throat Surgical Associates, P.a. | Otolaryngology | 1924 Marlton Pike E, Cherry Hill, NJ 08003-2118 | 2006-06-30 |
| 1285660290 | Vicente T. Zapanta | Otolaryngology | 340 Ernston Rd, Parlin, NJ 08859-1938 | 2006-06-23 |
| 1407320872 | Msk Surgery Nj | Otolaryngology | 480 Red Hill Rd, Middletown, NJ 07748-3052 | 2019-01-18 |
| 1669924718 | Ear, Nose and Throat Group of Central New Jersey | Otolaryngology | 2124 Oak Tree Rd Fl 2, Edison, NJ 08820 | 2016-10-25 |
| Find all providers with the same taxonomy | ||||
| City | NEW BRUNSWICK |
| Zip Code | 08901 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.