Healthcare Provider Details

I. General information

NPI: 1124931472
Provider Name (Legal Business Name): NANCY J MOONTASRI MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 PROSPECT ST STE 2
RIDGEWOOD NJ
07450-4433
US

IV. Provider business mailing address

1 MARS CT STE 1
BOONTON TWP NJ
07005-2422
US

V. Phone/Fax

Practice location:
  • Phone: 551-278-9776
  • Fax: 551-300-1306
Mailing address:
  • Phone: 917-328-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. NANCY J MOONTASRI
Title or Position: SOLE MEMBER/OWNER
Credential: MD
Phone: 917-328-2401