Provider Demographics
NPI:1194729475
Name:VOSOUGH, CYRUS (MD)
Entity type:Individual
Prefix:
First Name:CYRUS
Middle Name:
Last Name:VOSOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43092
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-0092
Mailing Address - Country:US
Mailing Address - Phone:973-595-0063
Mailing Address - Fax:973-720-0408
Practice Address - Street 1:504 HAMBURG TPKE STE B105
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2011
Practice Address - Country:US
Practice Address - Phone:973-595-0063
Practice Address - Fax:973-240-8990
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0706292081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8481008Medicaid
NJ8481008Medicaid
NJG88325Medicare UPIN