Provider Demographics
NPI:1659507275
Name:ESFAHANIZADEH, ABDOLREZA (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDOLREZA
Middle Name:
Last Name:ESFAHANIZADEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ABDOLREZA
Other - Middle Name:
Other - Last Name:ESFAHANI ZADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:66 WEST GILBERT STREET
Mailing Address - Street 2:2ND FL.
Mailing Address - City:REDBANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4206
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:89 FRENCH STREET
Practice Address - Street 2:CHINJ
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-235-7875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08752500208000000X, 2084N0600X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0253171Medicaid
NJ203647C6WMedicare PIN