Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 25MB08686700 | NJ |
N | 207U00000X | Nuclear Medicine Specialist | 275699 | NY |
NPI | 1225398761 |
---|---|
Provider Name | Dr. Mohammad-Ali Mousavi |
First Address | Edison, NJ 08820-2117 |
Second Address | Newark, NJ 07112-2027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2012 |
Last Update Date | 18/08/2014 |