Healthcare Provider Details

I. General information

NPI: 1629209333
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: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 BOYDEN AVE
MAPLEWOOD NJ
07040-3070
US

IV. Provider business mailing address

50 NEWARK AVE SUITE 101
BELLEVILLE NJ
07109-1185
US

V. Phone/Fax

Practice location:
  • Phone: 973-761-5200
  • Fax: 973-761-7617
Mailing address:
  • Phone: 973-759-1221
  • Fax: 973-759-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

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