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General NPI Number Information
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NPI Number | 1053669879
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Entity Type | Organization
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Legal Business Name | HOMAYOUN HOMAYOUNI MD PC
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 334 W OAKCREST AVE
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1716
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Country | US
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Telephone | 609-488-0808
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Fax | 609-485-0737
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Provider Business Mailing Address
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Address Line | 334 W OAKCREST AVE
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1716
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Country | US
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Telephone | 609-488-0808
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Fax | 609-485-0737
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Authorized Official
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Title or Position | OWNER
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Name | HOMAYOUN HOMAYOUNI
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Credential | MD
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Telephone | 609-485-0808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 25MA03418200
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License Number State | NJ
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