Provider Demographics
NPI:1831329291
Name:DASTJERDI, MOHAMMAD HOSSEIN (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:HOSSEIN
Last Name:DASTJERDI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:90 BERGEN ST
Mailing Address - Street 2:DOCTORS OFFICE CENTER, SUITE 6100
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2425
Mailing Address - Country:US
Mailing Address - Phone:973-972-2038
Mailing Address - Fax:973-972-2068
Practice Address - Street 1:90 BERGEN ST
Practice Address - Street 2:DOCTORS OFFICE CENTER, SUITE 6100
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-2038
Practice Address - Fax:973-972-2068
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2020-10-10
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA09381100207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist