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General NPI Number Information
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NPI Number | 1821234626
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Entity Type | Organization
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Legal Business Name | ALIREZA A. FOROUSHANI, PC
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Dates
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Enumeration Date | 12/29/2008
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Last Update Date | 04/20/2009
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Provider Practice Location Address
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Address Line | 260 GODWIN AVE SUITE 7
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City | WYCKOFF
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State | NJ
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Zip | 07481-5200
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Country | US
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Telephone | 201-485-7518
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Fax | 201-485-7517
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Provider Business Mailing Address
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Address Line | 260 GODWIN AVE SUITE 7
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City | WYCKOFF
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State | NJ
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Zip | 07481-5200
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Country | US
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Telephone | 201-485-7518
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Fax | 201-485-7517
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALIREZA ABTAHI FOROUSHANI
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Credential | D.C.
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Telephone | 201-485-7518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 38MC00658900
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License Number State | NJ
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