Provider Demographics
NPI:1851332704
Name:GARMKHORANI, ABOLGHASSEM (MD)
Entity Type:Individual
Prefix:
First Name:ABOLGHASSEM
Middle Name:
Last Name:GARMKHORANI
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 1:3333 ROUTE 9
Mailing Address - Street 2:CHADWICK SQUARE
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8503
Mailing Address - Country:US
Mailing Address - Phone:732-683-1975
Mailing Address - Fax:
Practice Address - Street 1:3333 ROUTE 9
Practice Address - Street 2:CHADWICK SQUARE
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8503
Practice Address - Country:US
Practice Address - Phone:732-683-1975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA059627207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ639005Medicaid
NJ585259Medicare PIN
G19609Medicare UPIN