Provider Demographics
NPI:1598846990
Name:HOOSHANGI, NOSSRATOLLAH (MD)
Entity Type:Individual
Prefix:
First Name:NOSSRATOLLAH
Middle Name:
Last Name:HOOSHANGI
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 1:93 JAMES ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3902
Mailing Address - Country:US
Mailing Address - Phone:732-549-9082
Mailing Address - Fax:732-549-9251
Practice Address - Street 1:93 JAMES ST
Practice Address - Street 2:SUITE 309
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3902
Practice Address - Country:US
Practice Address - Phone:732-549-9082
Practice Address - Fax:732-549-9251
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03256800207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0670502Medicaid
C56238Medicare UPIN
NJ0670502Medicaid