MEDICARE: PARVIZ MOAZAMI,M.D. LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	25MA05018800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770778979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARVIZ MOAZAMI,M.D. LLC

Provider Business Mailing Address
First Line	:	7000 BOULEVARD EAST
Second Line	:
City	:	GUTTENBERG
State	:	NJ
Zip	:	07093-4818
Country	:	US
Telephone Number	:	201-868-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 BOULEVARD EAST
Second Line	:
City	:	GUTTENBERG
State	:	NJ
Zip	:	07093-4818
Country	:	US
Telephone Number	:	201-868-8400
Fax Number	:

Authorized Official
Title or Position	:	M.D. LLC
Name	:	DR. PARVIZ MOAZAMI
Credential	:	M.D.
Telephone Number	:	201-868-8400

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	09/11/2007

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