Individual
AZAM SOROUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
61 DAVIS AVE, STE 1, NEPTUNE, NJ 07753-4401
(732) 776-4860
(732) 776-4867
Mailing address
61 DAVIS AVE, STE 1, NEPTUNE, NJ 07753-4401
(732) 776-4860
(732) 776-4867
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
25MA06860600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7232306
—
NJ
Enumeration date
03/16/2006
Last updated
01/24/2017
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