Provider Demographics
NPI:1093745473
Name:DANESHVAR, BEHDOKHT (MD)
Entity Type:Individual
Prefix:
First Name:BEHDOKHT
Middle Name:
Last Name:DANESHVAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 NEW RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1660
Mailing Address - Country:US
Mailing Address - Phone:609-485-0300
Mailing Address - Fax:609-646-7140
Practice Address - Street 1:1015 NEW RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1660
Practice Address - Country:US
Practice Address - Phone:609-485-0300
Practice Address - Fax:609-646-7140
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA069585207R00000X
NJ25MA06958500208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8024804Medicaid
NJHO1542Medicare UPIN
NJ030297Medicare PIN