Provider Demographics
NPI:1699213165
Name:VOORHEES MEDICAL HOME
Entity Type:Organization
Organization Name:VOORHEES MEDICAL HOME
Other - Org Name:MIRMANESH MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:MIRMANESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-238-0870
Mailing Address - Street 1:100 ROUTE 73
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-9575
Mailing Address - Country:US
Mailing Address - Phone:856-753-7374
Mailing Address - Fax:856-753-1137
Practice Address - Street 1:100 ROUTE 73
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9575
Practice Address - Country:US
Practice Address - Phone:856-753-7374
Practice Address - Fax:856-753-1137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-05
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06842200207Q00000X
NJ25MA09026400208000000X
NJ25MA09469200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty