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General NPI Number Information
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NPI Number | 1255738050
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Entity Type | Organization
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Legal Business Name | PUREMED LLC
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 02/05/2015
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Provider Practice Location Address
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Address Line | 200 ENGLE ST
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2440
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Country | US
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Telephone | 201-608-5284
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Fax | 201-608-5289
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Provider Business Mailing Address
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Address Line | 200 ENGLE ST SUITE 21
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2440
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Country | US
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Telephone | 201-608-5284
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Fax | 201-608-5289
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Authorized Official
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Title or Position | OWNER/ MEDICAL DIRECTOR
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Name | DR. HORMOZ MOHTASHEMI
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Credential | M.D.
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Telephone | 201-608-5284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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