Healthcare Provider Details

I. General information

NPI: 1194807255
Provider Name (Legal Business Name): JADAN H ABBASSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 MAIN AVE
CLIFTON NJ
07011-2112
US

IV. Provider business mailing address

1618 MAIN AVE
CLIFTON NJ
07011-2112
US

V. Phone/Fax

Practice location:
  • Phone: 973-253-3400
  • Fax: 973-253-3818
Mailing address:
  • Phone: 973-253-3400
  • Fax: 973-253-3818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number25MA04585100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: