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General NPI Number Information
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NPI Number | 1639295686
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Entity Type | Individual
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Provider Name | OMID DARDASHTI M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 297 LAFAYETTE AVE
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City | HAWTHORNE
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State | NJ
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Zip | 07506-1919
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Country | US
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Telephone | 201-439-2625
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Fax |
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Provider Business Mailing Address
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Address Line | 1541 LEMOINE AVE APT. 2E
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City | FORT LEE
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State | NJ
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Zip | 07024-5649
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Country | US
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Telephone | 201-638-6617
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 25MA08190200
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License Number State | NJ
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