Provider Demographics
NPI:1164505442
Name:ASGARIAN, KOUROSH T (DO)
Entity Type:Individual
Prefix:MR
First Name:KOUROSH
Middle Name:T
Last Name:ASGARIAN
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Gender:M
Credentials:DO
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Mailing Address - Street 1:100 MADISON AVENUE
Mailing Address - Street 2:MID-ATLANTIC SURGICAL ASSOCIATES
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960
Mailing Address - Country:US
Mailing Address - Phone:973-971-7300
Mailing Address - Fax:973-984-7019
Practice Address - Street 1:1944 ROUTE 33 SUITE 201
Practice Address - Street 2:MID-ATLANTIC SURGICAL ASSOCIATES
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:732-776-4618
Practice Address - Fax:732-776-3765
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2016-04-05
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB06196200208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8780706Medicaid
781215Medicare PIN
G07743Medicare UPIN