Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 25MA05488600 | NJ |
NPI | 1104471184 |
---|---|
Provider Name | Ahmad Rajaii-Khorasani |
First Address | Rumson, NJ 07760-1130 |
Second Address | Long Branch, NJ 07740-6395 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2019 |
Last Update Date | 06/08/2019 |