Provider Demographics
NPI:1295017762
Name:GOLSAZ, CYRUS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:MICHAEL
Last Name:GOLSAZ
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 1:79 NJ-37 #103
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755
Mailing Address - Country:US
Mailing Address - Phone:732-678-0087
Mailing Address - Fax:
Practice Address - Street 1:79 ROUTE 37 W
Practice Address - Street 2:SUITE 103
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6405
Practice Address - Country:US
Practice Address - Phone:732-678-0087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD758752085R0202X
PAMD4450682085R0202X
NY2664802085R0202X
NJ25MA091925002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029704810001Medicaid
NY07873269Medicaid
NYJ400153973Medicare PIN