MEDICARE: HOUSE CALL MEDICAL SERVICES OF NEW JERSEY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	363LF0000X	Family Nurse Practitioner
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1043173800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSE CALL MEDICAL SERVICES OF NEW JERSEY

Provider Business Mailing Address
First Line	:	2626 HALPERIN AVE FL 1
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 VALLEY RD # 229
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-2709
Country	:	US
Telephone Number	:	718-561-2121
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHERVIN MORTAZAVI
Credential	:	MD
Telephone Number	:	646-350-1619

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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