Provider Demographics
NPI:1770778979
Name:PARVIZ MOAZAMI,M.D. LLC
Entity type:Organization
Organization Name:PARVIZ MOAZAMI,M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:PARVIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MOAZAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-868-8400
Mailing Address - Street 1:7000 BOULEVARD EAST
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4818
Mailing Address - Country:US
Mailing Address - Phone:201-868-8400
Mailing Address - Fax:
Practice Address - Street 1:7000 BOULEVARD EAST
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-4818
Practice Address - Country:US
Practice Address - Phone:201-868-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05018800305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ062302Medicaid
NJ444723Medicare UPIN