Provider Demographics
NPI:1629046248
Name:MOSSAVI, AHMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:
Last Name:MOSSAVI
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 1:3200 SUNSET AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4556
Mailing Address - Country:US
Mailing Address - Phone:732-502-0710
Mailing Address - Fax:732-502-4882
Practice Address - Street 1:3200 SUNSET AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4556
Practice Address - Country:US
Practice Address - Phone:732-502-0710
Practice Address - Fax:732-502-4882
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA58130207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5229502Medicaid
NJ5229502Medicaid
NJ727261Medicare ID - Type Unspecified