Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 25MA07661900 | NJ |
N | 207PP0204X | Pediatric Emergency Physician | 25MA07661900 | NJ |
N | 208000000X | Pediatrician | 25MA07661900 | NJ |
NPI | 1326074030 |
---|---|
Provider Name | Hosseinali Shahidi |
First Address | Newark, NJ 07107-3000 |
Second Address | Newark, NJ 07103-2496 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 21/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0043923 | (05) | NJ |
C11497 | (02) |