Provider Demographics
NPI:1376508432
Name:ROZEHZADEH, RABIN (MD)
Entity Type:Individual
Prefix:DR
First Name:RABIN
Middle Name:
Last Name:ROZEHZADEH
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 1:1810 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5522
Mailing Address - Country:US
Mailing Address - Phone:908-226-1810
Mailing Address - Fax:908-226-1833
Practice Address - Street 1:1810 PARK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5522
Practice Address - Country:US
Practice Address - Phone:908-226-1810
Practice Address - Fax:908-226-1833
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07940100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0079197Medicaid
NJ128692Medicare PIN
NJI44480Medicare UPIN