Healthcare Provider Details

I. General information

NPI: 1801383385
Provider Name (Legal Business Name): MORTEZA TAROKH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 406
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

331 NEWMAN SPRINGS RD BLDG 2, STE 220
RED BANK NJ
07701-5688
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2608
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number25MA11998400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: