Provider Demographics
NPI:1982634952
Name:ASHTYANI ASL, HORMOZ (MD)
Entity type:Individual
Prefix:DR
First Name:HORMOZ
Middle Name:
Last Name:ASHTYANI ASL
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 1:331 NEWMAN SPRINGS RD
Mailing Address - Street 2:BLDG 2, STE 220
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5688
Mailing Address - Country:US
Mailing Address - Phone:732-807-0877
Mailing Address - Fax:201-751-1680
Practice Address - Street 1:186 ROCHELLE AVE
Practice Address - Street 2:2ND FL
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662
Practice Address - Country:US
Practice Address - Phone:201-968-5345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03206900207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ202384218OtherCIGNA
NJ202384218OtherUNITED HEALTHCARE
NJBP484OtherOXFORD
NJ1881302Medicaid
NJ1881302Medicaid
NJ202384218OtherCIGNA