Individual
MR. FAZLOLLAH GOLESTANEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
66 TANNER STREET, SAM RADIOLOGY SERVICES, LLC, HADDONFIELD, NJ 08033
(856) 507-9512
(856) 507-9516
Mailing address
PO BOX 2300, SAM RADIOLOGY SERVICES, LLC, VINELAND, NJ 08362-2300
(856) 507-9512
(856) 507-9516
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
25MA03109900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2323206
—
NJ
Enumeration date
09/26/2006
Last updated
01/30/2009
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