Provider Demographics
NPI:1225398761
Name:MOUSAVI, MOHAMMAD-ALI (DO)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD-ALI
Middle Name:
Last Name:MOUSAVI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:MOUSAVI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:5 DONNA DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2117
Mailing Address - Country:US
Mailing Address - Phone:732-261-0628
Mailing Address - Fax:
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08686700207U00000X, 2085R0202X, 2085R0204X
390200000X
NY2756992085R0204X, 207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology