Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 25MA09513900 | NJ |
N | 207YS0123X | Facial Plastic Surgeon | 25MA09513900 | NJ |
NPI | 1841480274 |
---|---|
Provider Name | Dr. Kianoush Sheykholeslami |
First Address | New Brunswick, NJ 08901-1766 |
Second Address | New Brunswick, NJ 08901-1766 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2007 |
Last Update Date | 30/07/2020 |