| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 10/23/2013 |
| Last Update Date | 11/13/2014 |
| Medicare PECOS PAC ID | 2961632054 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1346273778 PECOS PAC ID: 9335104637 Enrollment ID: I20120227000312 |
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