Provider Demographics
NPI:1346273778
Name:FOROUZESH, AVISHEH (MD)
Entity Type:Individual
Prefix:
First Name:AVISHEH
Middle Name:
Last Name:FOROUZESH
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 1:330 WASHINGTON ST
Mailing Address - Street 2:PMB #603
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4883
Mailing Address - Country:US
Mailing Address - Phone:201-238-2888
Mailing Address - Fax:
Practice Address - Street 1:331 GRAND ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2719
Practice Address - Country:US
Practice Address - Phone:201-238-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA 09020700207RI0200X
NY232351207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY232351OtherLICENSE