Provider Demographics
NPI:1912952607
Name:GHOBADI, FEREYDOON (MD)
Entity Type:Individual
Prefix:DR
First Name:FEREYDOON
Middle Name:
Last Name:GHOBADI
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 1:504 VALLEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3534
Mailing Address - Country:US
Mailing Address - Phone:973-942-1315
Mailing Address - Fax:973-942-8724
Practice Address - Street 1:504 VALLEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3534
Practice Address - Country:US
Practice Address - Phone:973-942-1315
Practice Address - Fax:973-942-8724
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46248207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0837903Medicaid
563214Medicare ID - Type Unspecified
NJE23754Medicare UPIN