Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 22DI02722800 | NJ |
N | 1223G0001X | General Practice | 22DI02722800 | NJ |
N | 213EG0000X | General Practice | 22DI02722800 | NJ |
NPI | 1003394453 |
---|---|
Provider Name | Dr. Viqar H Moosavi |
First Address | Mickleton, NJ 08056-1024 |
Second Address | Lumberton, NJ 08048-2987 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2018 |
Last Update Date | 29/07/2018 |