Provider Demographics
NPI:1679677918
Name:SASANPOUR, MAJID (MD)
Entity Type:Individual
Prefix:
First Name:MAJID
Middle Name:
Last Name:SASANPOUR
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:PO BOX 110147
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-0903
Mailing Address - Country:US
Mailing Address - Phone:973-667-8117
Mailing Address - Fax:973-667-6642
Practice Address - Street 1:181 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3820
Practice Address - Country:US
Practice Address - Phone:973-667-8117
Practice Address - Fax:973-667-6642
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07282700207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD08338100OtherCDS
NJ9131400Medicaid
NJ9131400Medicaid
NJ9131400Medicaid