Individual
ZIA GHAVAMI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
119 PROSPECT ST, RIDGEWOOD, NJ 07450-4405
(201) 445-1212
Mailing address
119 PROSPECT ST, RIDGEWOOD, NJ 07450-4405
(201) 445-1212
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
145846
NY
208000000X
Pediatrics Physician
Primary
25MA04003700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00589368
—
NY
05
—
3821200
—
NJ
Enumeration date
06/18/2006
Last updated
04/23/2012
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