Provider Demographics
NPI:1700083763
Name:HAGIGI, MERSHAD (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MERSHAD
Middle Name:
Last Name:HAGIGI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19-04 FAIR LAWN AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410
Mailing Address - Country:US
Mailing Address - Phone:201-563-2525
Mailing Address - Fax:
Practice Address - Street 1:375 E MAIN ST
Practice Address - Street 2:SUITE 12
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-665-2261
Practice Address - Fax:631-665-5535
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA090054002085R0202X
NY2633942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology