Provider Demographics
NPI:1053501460
Name:MOEIN F. VASEGHI, MD, PA
Entity Type:Organization
Organization Name:MOEIN F. VASEGHI, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOEIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:VASEGHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-662-1912
Mailing Address - Street 1:24 SENTINEL DR
Mailing Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07840500261QM2500X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care