Provider Demographics
NPI:1083686174
Name:HOMAYOUNI, HOMAYOUN (MD)
Entity Type:Individual
Prefix:MR
First Name:HOMAYOUN
Middle Name:
Last Name:HOMAYOUNI
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 1:205 HEMLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221
Mailing Address - Country:US
Mailing Address - Phone:609-485-0808
Mailing Address - Fax:609-485-0737
Practice Address - Street 1:334 W OAKCREST AVE
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1716
Practice Address - Country:US
Practice Address - Phone:609-485-0808
Practice Address - Fax:609-485-0737
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03418200207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ088508Medicaid
NJ181396Medicare ID - Type Unspecified
NJ088508Medicaid