| Doctor Name: | DR. HORMOZ MOHTASHEMI |
| NPI Number: | 1851304562 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | MAD02603900 |
| Business Practice Address: | 516 Hamburg Tpke Suite 11 Wayne, NJ - 074702062 |
| Business Phone Number: | 9739568080 |
| Business Fax Number: | 9737900450 |
| Mailing Address: | 516 Hamburg Tpke, Suite 11 WAYNE |
| State: | NJ |
| Postal Code: | 074702062 |
| Phone Number: | 9739568080 |
| Fax Number: | 9737900450 |
| NPI Enumeration Date: | 08/14/2006 |
| NPI Last Update Date: | 09/10/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MAD02603900 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |