Provider Demographics
NPI:1689820011
Name:BABALAVI, PARVIZ (MD)
Entity Type:Individual
Prefix:
First Name:PARVIZ
Middle Name:
Last Name:BABALAVI
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 1:125 MONMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1311
Mailing Address - Country:US
Mailing Address - Phone:908-925-2565
Mailing Address - Fax:908-925-2565
Practice Address - Street 1:437 N WOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4100
Practice Address - Country:US
Practice Address - Phone:908-925-2565
Practice Address - Fax:908-925-2565
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA39570208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
445955Medicare PIN