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General NPI Number Information
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NPI Number | 1124931472
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Entity Type | Organization
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Legal Business Name | NANCY J MOONTASRI MD LLC
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 106 PROSPECT ST STE 2
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-4433
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Country | US
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Telephone | 551-278-9776
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Fax | 551-300-1306
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Provider Business Mailing Address
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Address Line | 1 MARS CT STE 1
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City | BOONTON TWP
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State | NJ
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Zip | 07005-2422
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Country | US
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Telephone | 917-328-2401
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER/OWNER
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Name | DR. NANCY J MOONTASRI
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Credential | MD
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Telephone | 917-328-2401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | NULL
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