Provider Demographics
NPI:1841353794
Name:ABESSI, HOSSEIN (MD)
Entity type:Individual
Prefix:DR
First Name:HOSSEIN
Middle Name:
Last Name:ABESSI
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 1:502 HAMBURG TPKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-8431
Mailing Address - Country:US
Mailing Address - Phone:973-595-7646
Mailing Address - Fax:973-595-0141
Practice Address - Street 1:502 HAMBURG TPKE
Practice Address - Street 2:SUITE 102
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8431
Practice Address - Country:US
Practice Address - Phone:973-595-7646
Practice Address - Fax:973-595-0141
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02596600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0649104Medicaid
NJC53244Medicare UPIN
NJ101596Medicare ID - Type Unspecified