Healthcare Provider Details

I. General information

NPI: 1659507275
Provider Name (Legal Business Name): ABDOLREZA ESFAHANIZADEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ABDOLREZA ESFAHANI ZADEH MD

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 FRENCH STREET CHINJ
NEW BRUNSWICK NJ
08901
US

IV. Provider business mailing address

66 WEST GILBERT STREET 2ND FL.
REDBANK NJ
07701-4206
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-7875
  • Fax:
Mailing address:
  • Phone: 732-212-0051
  • Fax: 732-212-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08752500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number25MA08752500
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number25MA08752500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: