1871668137 NPI number — NOUSHIN NASRI-GHAJARI DDS

Table of content: NOUSHIN NASRI-GHAJARI DDS (NPI 1871668137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871668137 NPI number — NOUSHIN NASRI-GHAJARI DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NASRI-GHAJARI
Provider First Name:
NOUSHIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871668137
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
163 ALPINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLOSTER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07624-2811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-741-9565
Provider Business Mailing Address Fax Number:
201-302-9845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2225 LEMOINE AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LEE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-741-9565
Provider Business Practice Location Address Fax Number:
201-302-9845
Provider Enumeration Date:
11/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  19447 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)