Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MA77375 | NJ |
N | 208600000X | Surgeon | MA77375 | NJ |
N | 2082S0105X | Plastic Hand Surgeon | MA77375 | NJ |
Y | 2086S0122X | Plastic and Reconstructive Surgery | MA77375 | NJ |
NPI | 1699762435 |
---|---|
Provider Name | Dr. Reza Momeni |
First Address | Berkeley Heights, NJ 07922-2104 |
Second Address | Berkeley Heights, NJ 07922-2104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 18/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I44277 | (02) | NJ |