Provider Demographics
NPI:1003888934
Name:REZVANI, ABAS ANDRE (MD)
Entity Type:Individual
Prefix:DR
First Name:ABAS
Middle Name:ANDRE
Last Name:REZVANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:220 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2132
Mailing Address - Country:US
Mailing Address - Phone:973-790-1100
Mailing Address - Fax:973-790-3138
Practice Address - Street 1:220 HAMBURG TPKE
Practice Address - Street 2:10
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2110
Practice Address - Country:US
Practice Address - Phone:973-790-1100
Practice Address - Fax:973-790-3138
Is Sole Proprietor?:No
Enumeration Date:2006-02-04
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ29409208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53320Medicare UPIN