Provider Demographics
NPI:1487717088
Name:NAZLY M. SHARIATI MD PA
Entity type:Organization
Organization Name:NAZLY M. SHARIATI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAZLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-273-4949
Mailing Address - Street 1:16 CHELSEA CT
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2573
Mailing Address - Country:US
Mailing Address - Phone:908-273-4949
Mailing Address - Fax:908-255-6105
Practice Address - Street 1:99 BEAUVOIR AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3533
Practice Address - Country:US
Practice Address - Phone:908-273-4949
Practice Address - Fax:908-522-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06634100208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0053759Medicaid
NJH68996Medicare UPIN
NJ087873Medicare PIN