Provider Demographics
NPI:1558559153
Name:M R A NEJAD MD PC
Entity Type:Organization
Organization Name:M R A NEJAD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:M REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIAEY-NEJAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-831-0471
Mailing Address - Street 1:22 SHERWOOD HTS
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-3409
Mailing Address - Country:US
Mailing Address - Phone:845-831-0471
Mailing Address - Fax:845-831-0306
Practice Address - Street 1:560 ROUTE 52
Practice Address - Street 2:SUITE 102
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-1208
Practice Address - Country:US
Practice Address - Phone:845-831-0471
Practice Address - Fax:845-831-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158736207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00847452Medicaid
NY00847452Medicaid
WEK401Medicare PIN