Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | MA35399 | NJ |
NPI | 1043434558 |
---|---|
Provider Name | Dr. Hessam Moheimani |
First Address | Westmont, NJ 08108-2734 |
Second Address | Westmont, NJ 08108-2734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3466809 | (05) | NJ |
C52681 | (02) |