Provider Demographics
NPI:1083796189
Name:H. ASHTYANI, MD PA
Entity Type:Organization
Organization Name:H. ASHTYANI, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HORMOZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHTYANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-996-0308
Mailing Address - Street 1:PO BOX 2143
Mailing Address - Street 2:
Mailing Address - City:SOUTH HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07606-0743
Mailing Address - Country:US
Mailing Address - Phone:201-996-0308
Mailing Address - Fax:201-996-0242
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:SUITE 615
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1997
Practice Address - Country:US
Practice Address - Phone:201-996-0308
Practice Address - Fax:201-996-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096428Medicare ID - Type Unspecified