Provider Demographics
NPI:1770942849
Name:PIONEER MEDICAL GROUP LLC
Entity type:Organization
Organization Name:PIONEER MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TASHAROFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-443-1700
Mailing Address - Street 1:2005 ST GEORGE'S AVE
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065
Mailing Address - Country:US
Mailing Address - Phone:732-381-3740
Mailing Address - Fax:732-587-5486
Practice Address - Street 1:2005 ST GEORGE'S AVE
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065
Practice Address - Country:US
Practice Address - Phone:732-381-3740
Practice Address - Fax:732-587-5486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07616500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty