Provider Demographics
NPI:1659673937
Name:YADOLLAH GORJI MD PA
Entity Type:Organization
Organization Name:YADOLLAH GORJI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PATHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:YADOLLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GORJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-601-8522
Mailing Address - Street 1:42 LACOSTA DR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5839
Mailing Address - Country:US
Mailing Address - Phone:609-601-8522
Mailing Address - Fax:609-601-8522
Practice Address - Street 1:42 LACOSTA DR
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5839
Practice Address - Country:US
Practice Address - Phone:609-601-8522
Practice Address - Fax:609-601-8522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02774400207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty