Provider Demographics
NPI:1003892779
Name:FAGHIH VASEGHI, MOEIN (MD)
Entity Type:Individual
Prefix:
First Name:MOEIN
Middle Name:
Last Name:FAGHIH VASEGHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SENTINEL DR
Mailing Address - Street 2:24 SENTINEL DR
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-4233
Mailing Address - Country:US
Mailing Address - Phone:908-889-4600
Mailing Address - Fax:908-889-5527
Practice Address - Street 1:104 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2427
Practice Address - Country:US
Practice Address - Phone:908-889-4600
Practice Address - Fax:908-889-5527
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07840500207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0076848Medicaid
NJD08660300OtherCDS
NJ134050Medicare UPIN
NJ0076848Medicaid