Provider Demographics
NPI:1356516082
Name:TEHRANIRAD, MOHAMMAD (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:TEHRANIRAD
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 1:1 RIVER CT
Mailing Address - Street 2:APT # 406
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2001
Mailing Address - Country:US
Mailing Address - Phone:703-944-6639
Mailing Address - Fax:
Practice Address - Street 1:1 RIVER CT
Practice Address - Street 2:APT # 406
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-2001
Practice Address - Country:US
Practice Address - Phone:703-944-6639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08517400208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00836921OtherRR MEDICARE - TEANECK HOSPITALISTS
NJ0190543Medicaid
NJ48088OtherUHP-PHYS ASSOC OF TEANECK
NJP00765827OtherRR MEDICARE
NJ148582UXWMedicare PIN
NJP00836921OtherRR MEDICARE - TEANECK HOSPITALISTS
NJ148582ZC79Medicare PIN