Provider Demographics
NPI:1528233202
Name:FOROUSH, PEJMAN (MD)
Entity Type:Individual
Prefix:
First Name:PEJMAN
Middle Name:
Last Name:FOROUSH
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 1:5 CHADWICK DR
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2928
Mailing Address - Country:US
Mailing Address - Phone:516-297-9233
Mailing Address - Fax:732-234-6130
Practice Address - Street 1:727 N BEERS ST
Practice Address - Street 2:BAYSHORE COMMUNITY HOSPITAL
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1514
Practice Address - Country:US
Practice Address - Phone:516-297-9233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0292900207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00641799OtherRR MCR PTAN
NJ0180777Medicaid
NJ126734CDZMedicare PIN
NJ126734A01Medicare PIN