=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063151652
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANIEL FEGHHI MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2022
-----------------------------------------------------
Last Update Date | 06/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 E BLACKWELL ST STE 28
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07801-4645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-494-8244
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 734
-----------------------------------------------------
City | ORADELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07649-0734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-546-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DANIEL FEGHHI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 862-668-5061
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------