Provider Demographics
NPI:1831365303
Name:LOGHMANEE, CYRUS FAZ (MD)
Entity type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:FAZ
Last Name:LOGHMANEE
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:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-0442
Mailing Address - Country:US
Mailing Address - Phone:201-449-1000
Mailing Address - Fax:
Practice Address - Street 1:79 HUDSON ST
Practice Address - Street 2:SUITE 700
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5638
Practice Address - Country:US
Practice Address - Phone:201-449-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30497208200000X
NJ25MA08921100208200000X
NY260309208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery