Advanced Infectious Disease Medical, Llc | |
331 Grand St Ground Floor Hoboken NJ 07030-2719 | |
(201) 238-2888 | |
Not Available |
Full Name | Advanced Infectious Disease Medical, Llc |
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Speciality | Internal Medicine |
Location | 331 Grand St, Hoboken, New Jersey |
Authorized Official Name and Position | Avisheh Forouzesh (PHYSICIAN) |
Authorized Official Contact | 2012382888 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Advanced Infectious Disease Medical, Llc 330 Washington St Pmb #603 Hoboken NJ 07030-4883 Ph: (201) 238-2888 | Advanced Infectious Disease Medical, Llc 331 Grand St Ground Floor Hoboken NJ 07030-2719 Ph: (201) 238-2888 |
NPI Number | 1730517053 |
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Provider Enumeration Date | 10/23/2013 |
Last Update Date | 11/13/2014 |
Medicare PECOS PAC ID | 2961632054 |
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Medicare Enrollment ID | O20140312000490 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730517053 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RI0200X | Internal Medicine - Infectious Disease | 25MA09020700 (New Jersey) | Primary |
Provider Name | Avisheh Forouzesh |
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Provider Type | Practitioner - Infectious Disease |
Provider Identifiers | NPI Number: 1346273778 PECOS PAC ID: 9335104637 Enrollment ID: I20120227000312 |
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