Healthcare Provider Details

I. General information

NPI: 1053501460
Provider Name (Legal Business Name): MOEIN F. VASEGHI, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
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
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 TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number25MA07840500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number25MA07840500
License Number StateNJ

VIII. Authorized Official

Name: DR. MOEIN F VASEGHI
Title or Position: DIRECTOR
Credential: MD
Phone: 646-662-1912