Provider Demographics
NPI:1639295686
Name:DARDASHTI, OMID (MD)
Entity Type:Individual
Prefix:DR
First Name:OMID
Middle Name:
Last Name:DARDASHTI
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 1:1541 LEMOINE AVE
Mailing Address - Street 2:APT. 2E
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5649
Mailing Address - Country:US
Mailing Address - Phone:201-638-6617
Mailing Address - Fax:
Practice Address - Street 1:297 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-1919
Practice Address - Country:US
Practice Address - Phone:201-439-2625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08190200207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease