Provider Demographics
NPI:1447512835
Name:BEHDOKHT DANESHVAR, LLC
Entity type:Organization
Organization Name:BEHDOKHT DANESHVAR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEHDOKHT
Authorized Official - Middle Name:
Authorized Official - Last Name:DANESHVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-485-0300
Mailing Address - Street 1:1015 NEW RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1600
Mailing Address - Country:US
Mailing Address - Phone:609-926-6900
Mailing Address - Fax:609-926-6900
Practice Address - Street 1:408 BETHEL RD
Practice Address - Street 2:SUITE C-2
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2172
Practice Address - Country:US
Practice Address - Phone:609-926-6900
Practice Address - Fax:609-926-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06958500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8024804Medicaid
H01542Medicare UPIN
NJ030297Medicare PIN