Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | MA070629 | NJ |
NPI | 1194729475 |
---|---|
Provider Name | Cyrus Vosough |
First Address | Upper Montclair, NJ 07043-0092 |
Second Address | Wayne, NJ 07470-2011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2005 |
Last Update Date | 24/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8481008 | (05) | NJ |
G88325 | (02) | NJ |