Healthcare Provider Details

I. General information

NPI: 1871724583
Provider Name (Legal Business Name): EMPIRE MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 POLIFLY RD SUITE 207
HACKENSACK NJ
07601-1758
US

IV. Provider business mailing address

50 NEWARK AVE SUITE 101
BELLEVILLE NJ
07109-1185
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-1991
  • Fax: 201-489-3633
Mailing address:
  • Phone: 973-759-1221
  • Fax: 973-759-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. NADER MOAVEN
Title or Position: PRESIDENT
Credential: MD
Phone: 973-759-1221