Provider Demographics
NPI:1891962528
Name:MIRMADJLESSI, NOUSHIN (MD)
Entity Type:Individual
Prefix:DR
First Name:NOUSHIN
Middle Name:
Last Name:MIRMADJLESSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CORNWALL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3311
Mailing Address - Country:US
Mailing Address - Phone:732-698-1000
Mailing Address - Fax:732-698-1008
Practice Address - Street 1:3 CORNWALL DR
Practice Address - Street 2:SUITE A
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3311
Practice Address - Country:US
Practice Address - Phone:732-698-1000
Practice Address - Fax:732-698-1008
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
283X00000X
NJ25MA08812000208100000X, 2081S0010X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No283X00000XHospitalsRehabilitation Hospital
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine