MEDICARE: DR. ABAS ANDRE REZVANI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	29409	NJ

General Provider Information

NPI Number	:	1003888934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABAS ANDRE REZVANI MD

Provider Business Mailing Address
First Line	:	220 HAMBURG TPKE
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2132
Country	:	US
Telephone Number	:	973-790-1100
Fax Number	:	973-790-3138

Provider Business Practice Location Address
First Line	:	220 HAMBURG TPKE
Second Line	:	10
City	:	WAYNE
State	:	NJ
Zip	:	07470-2110
Country	:	US
Telephone Number	:	973-790-1100
Fax Number	:	973-790-3138

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2006
Last Update Date	:	04/03/2009

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