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General NPI Number Information
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NPI Number | 1851304562
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Entity Type | Individual
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Provider Name | HORMOZ MOHTASHEMI MD
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Gender | Male
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 516 HAMBURG TPKE SUITE 11
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City | WAYNE
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State | NJ
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Zip | 07470-2062
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Country | US
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Telephone | 973-956-8080
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Fax | 973-790-0450
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Provider Business Mailing Address
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Address Line | 516 HAMBURG TPKE SUITE 11
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City | WAYNE
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State | NJ
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Zip | 07470-2062
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Country | US
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Telephone | 973-956-8080
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Fax | 973-790-0450
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MAD02603900
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License Number State | NJ
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