Healthcare Provider Details

I. General information

NPI: 1215192083
Provider Name (Legal Business Name): PARVIN AZIZI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 12/02/2024
Certification Date: 11/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NEURABILITIES 2050 VOORHEES TOWN CENTER
VORHEES TOWNSHIP NJ
08043
US

IV. Provider business mailing address

132 BRIDGE BLVD
MOUNT HOLLY NJ
08060-4444
US

V. Phone/Fax

Practice location:
  • Phone: 856-346-0005
  • Fax:
Mailing address:
  • Phone: 832-866-7681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberD84819
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA142709
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD2013-0787
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA142709
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number25MA11010000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: