MEDICARE: DR. HORMOZ MOHTASHEMI MD

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	208D00000X	General Practice Physician	MAD02603900	NJ

General Provider Information

NPI Number	:	1851304562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HORMOZ MOHTASHEMI MD

Provider Business Mailing Address
First Line	:	516 HAMBURG TPKE
Second Line	:	SUITE 11
City	:	WAYNE
State	:	NJ
Zip	:	07470-2062
Country	:	US
Telephone Number	:	973-956-8080
Fax Number	:	973-790-0450

Provider Business Practice Location Address
First Line	:	516 HAMBURG TPKE
Second Line	:	SUITE 11
City	:	WAYNE
State	:	NJ
Zip	:	07470-2062
Country	:	US
Telephone Number	:	973-956-8080
Fax Number	:	973-790-0450

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	09/10/2007

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