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General NPI Number Information
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NPI Number | 1841630191
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Entity Type | Individual
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Provider Name | MESUM MOOSAVI MD
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Gender | Male
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Dates
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Enumeration Date | 07/01/2013
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 290 LAFAYETTE AVE
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City | HAWTHORNE
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State | NJ
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Zip | 07506-1961
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Country | US
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Telephone | 856-266-0445
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Fax |
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Provider Business Mailing Address
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Address Line | 830 MORRIS TPKE FL 4
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City | SHORT HILLS
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State | NJ
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Zip | 07078-2625
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Country | US
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Telephone |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | R73958
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 25MA10937100
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License Number State | NJ
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