Individual
SEPIDEH TARA ROUSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4 CORNWALL CT, EAST BRUNSWICK, NJ 08816-3331
(732) 613-9191
(732) 613-1139
Mailing address
4 CORNWALL CT, EAST BRUNSWICK, NJ 08816-3331
(732) 613-9191
(732) 613-1139
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
25MA06717300
NJ
207WX0110X
Pediatric Ophthalmology and Strabismus Specialist Physician
Primary
25MA06717300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7983409
—
NJ
Enumeration date
01/18/2006
Last updated
04/20/2020
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