Healthcare Provider Details

I. General information

NPI: 1003892779
Provider Name (Legal Business Name): MOEIN FAGHIH VASEGHI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N EUCLID AVE
WESTFIELD NJ
07090-2427
US

IV. Provider business mailing address

24 SENTINEL DR 24 SENTINEL DR
BASKING RIDGE NJ
07920-4233
US

V. Phone/Fax

Practice location:
  • Phone: 908-889-4600
  • Fax: 908-889-5527
Mailing address:
  • Phone: 908-889-4600
  • Fax: 908-889-5527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number25MA07840500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: