Provider Demographics
NPI:1992770168
Name:SHARIATI, NAZLY M (MD)
Entity type:Individual
Prefix:
First Name:NAZLY
Middle Name:M
Last Name:SHARIATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAZLY
Other - Middle Name:
Other - Last Name:MAKOUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07963-0123
Mailing Address - Country:US
Mailing Address - Phone:908-273-4949
Mailing Address - Fax:908-522-6105
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:CAROL G. SIMON CANCER CENTER
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:908-273-4949
Practice Address - Fax:908-522-6105
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06634100208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0053759Medicaid
NJ0053759Medicaid
NJ087397Medicare ID - Type Unspecified