Miragenex LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MIRAGENEX LLC

Practice address

125 Michael Dr Ste 106
Syosset, NY 11791-5311

Phone

(347) 669-1693

Fax

(516) 753-9964

NPI assigned

Apr 28, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mohamad A Khodair, MDNPI 1790353936

Title

Owner

Phone

(347) 669-1693

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mohamad A Khodair, MD, PHD

  • Independent Medical Examiner Physician
  • Pine Brook, NJ
  • NPI 1790353936
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1682640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682640000000",
    "number": "1205524014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 LITTLE FALLS RD STE E",
            "city": "FAIRFIELD",
            "state": "NJ",
            "postal_code": "070041913",
            "telephone_number": "347-669-1693",
            "fax_number": "516-753-9964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 MICHAEL DR STE 106",
            "city": "SYOSSET",
            "state": "NY",
            "postal_code": "117915311",
            "telephone_number": "347-669-1693",
            "fax_number": "516-753-9964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRAGENEX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-28",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A",
        "authorized_official_last_name": "KHODAIR",
        "authorized_official_first_name": "MOHAMAD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "347-669-1693",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Miller
• Mind Over Matter NP in Psychiatry and Family Health P.C.
• Mindful Clarity Psychotherapy LCSW, PLLC
• Gurpreet Minhas
• Fredric J Mintz, M.D.
• Mitchell Cooperman
• Muhsina Mobasshera
• Nicole Mobilio
• Connie L Modica, PT DPT MS
• Ambreen Moghni, SERVICE COORDINATOR

• Clinical Medical Laboratory in Syosset, NY
• Providers in Syosset, NY by specialty
• Clinical Medical Laboratory in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.