Provider Demographics
NPI:1861486623
Name:SHARIATI, NASSEREDIN (MD)
Entity Type:Individual
Prefix:MR
First Name:NASSEREDIN
Middle Name:
Last Name:SHARIATI
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 1:2345 LAMINGTON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-2612
Mailing Address - Country:US
Mailing Address - Phone:908-234-2295
Mailing Address - Fax:908-234-0579
Practice Address - Street 1:2345 LAMINGTON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-2612
Practice Address - Country:US
Practice Address - Phone:908-234-2295
Practice Address - Fax:908-234-0579
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04430000207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
C55022Medicare UPIN