Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MA02694700 | NJ |
N | 207RA0201X | Internist - Allergy & Immunology | 25MA04825700 | NJ |
N | 207V00000X | Obstetrician & Gynecologist | MA02694700 | NJ |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 25MA02694700 | NJ |
N | 2086S0129X | Vascular Surgeon | 25MA02694700 | NJ |
NPI | 1780697490 |
---|---|
Provider Name | Dr. Manouchehr T Shahab |
First Address | Midland Park, NJ 07432 |
Second Address | Midland Park, NJ 07432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 10/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D06197 | (02) |