Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 25MA03418200 | NJ |
NPI | 1083686174 |
---|---|
Provider Name | Mr. Homayoun Homayouni |
First Address | Linwood, NJ 08221 |
Second Address | Northfield, NJ 08225-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
088508 | (05) | NJ |
D18662 | (02) |