=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003892779
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOEIN FAGHIH VASEGHI M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2005
-----------------------------------------------------
Last Update Date | 10/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 N EUCLID AVE
-----------------------------------------------------
City | WESTFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07090-2427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-889-4600
-----------------------------------------------------
Fax | 908-889-5527
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 SENTINEL DR 24 SENTINEL DR
-----------------------------------------------------
City | BASKING RIDGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07920-4233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-889-4600
-----------------------------------------------------
Fax | 908-889-5527
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207UN0901X
-----------------------------------------------------
Taxonomy Name | Nuclear Cardiology Physician
-----------------------------------------------------
License Number | 25MA07840500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------