Provider Demographics
NPI:1861537359
Name:NARI MEDICAL ASSOCIATION LLC
Entity type:Organization
Organization Name:NARI MEDICAL ASSOCIATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSSAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-502-0710
Mailing Address - Street 1:3200 SUNSET AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4567
Mailing Address - Country:US
Mailing Address - Phone:732-502-0710
Mailing Address - Fax:732-502-4882
Practice Address - Street 1:3200 SUNSET AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4567
Practice Address - Country:US
Practice Address - Phone:732-502-0710
Practice Address - Fax:732-502-4882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA58130207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5229502Medicaid
NJ727261Medicare ID - Type Unspecified
NJ5229502Medicaid