Provider Demographics
NPI:1508546227
Name:MITRA, MOUSUMI SEAL
Entity type:Individual
Prefix:
First Name:MOUSUMI
Middle Name:SEAL
Last Name:MITRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 OLD CAMPLAIN RD STE 2H
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4394
Mailing Address - Country:US
Mailing Address - Phone:908-429-7799
Mailing Address - Fax:866-611-9616
Practice Address - Street 1:120 OLD CAMPLAIN RD STE 2H
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4394
Practice Address - Country:US
Practice Address - Phone:908-429-7799
Practice Address - Fax:866-611-9616
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14875700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily