Provider Demographics
NPI:1407949514
Name:MOOSVI, MIR A (MD)
Entity Type:Individual
Prefix:DR
First Name:MIR
Middle Name:A
Last Name:MOOSVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ABBAS
Other - Middle Name:A
Other - Last Name:MOOSVI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:717 N BEERS ST
Mailing Address - Street 2:STE 2C
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:717 N BEERS ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1524
Practice Address - Country:US
Practice Address - Phone:732-264-7411
Practice Address - Fax:732-264-1074
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03401800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2509707Medicaid
NJ029380TSEOtherMEDICARE LEGACY
NJ029380TSEOtherMEDICARE LEGACY