Provider Demographics
NPI:1932271871
Name:MOTEMADEN, PARVIN (MD)
Entity Type:Individual
Prefix:
First Name:PARVIN
Middle Name:
Last Name:MOTEMADEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 HWY 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754
Mailing Address - Country:US
Mailing Address - Phone:732-244-0777
Mailing Address - Fax:732-244-1428
Practice Address - Street 1:154 HWY 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08754
Practice Address - Country:US
Practice Address - Phone:732-244-0777
Practice Address - Fax:732-244-1428
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03698500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C55291Medicare UPIN
M0452133Medicare ID - Type Unspecified