Provider Demographics
NPI:1407095953
Name:ABAS REZVANI M.D., PA
Entity Type:Organization
Organization Name:ABAS REZVANI M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABAS
Authorized Official - Middle Name:
Authorized Official - Last Name:REZVANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-790-1100
Mailing Address - Street 1:220 HAMBURG TPK
Mailing Address - Street 2:SUITE NUMBER 10
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07417
Mailing Address - Country:US
Mailing Address - Phone:973-790-1100
Mailing Address - Fax:973-790-3138
Practice Address - Street 1:220 HAMBURG TPKE
Practice Address - Street 2:SUITE NUMBER 10
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2110
Practice Address - Country:US
Practice Address - Phone:973-790-1100
Practice Address - Fax:973-790-3138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02940900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110981Medicare UPIN