Provider Demographics
NPI:1386070340
Name:JADIDI, SHIRIN (MD)
Entity type:Individual
Prefix:DR
First Name:SHIRIN
Middle Name:
Last Name:JADIDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MCVICKERS LN
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-2936
Mailing Address - Country:US
Mailing Address - Phone:973-543-8861
Mailing Address - Fax:
Practice Address - Street 1:12 MCVICKERS LN
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-2936
Practice Address - Country:US
Practice Address - Phone:973-543-8861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05391800207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology