Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 25MA0898200 | NJ |
Y | 2081P2900X | Pain Medicine | 25MA08978200 | NJ |
N | 2081S0010X | Sports Medicine | 25MA0898200 | NJ |
N | 213ES0000X | Sports Medicine | 25MA0898200 | NJ |
NPI | 1366754293 |
---|---|
Provider Name | Dr. Mohammad Hossein Dorri |
First Address | Teaneck, NJ 07666-3640 |
Second Address | Cliffside Park, NJ 07010-3012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2010 |
Last Update Date | 27/12/2012 |