Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 29409 | NJ |
NPI | 1003888934 |
---|---|
Provider Name | Dr. Abas Andre Rezvani |
First Address | Wayne, NJ 07470-2132 |
Second Address | Wayne, NJ 07470-2110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2006 |
Last Update Date | 03/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C53320 | (02) | NJ |