Basic Information
| Provider Information | |||||||||
| NPI: | 1366754293 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DORRI | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | HOSSEIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 GALWAY PL | ||||||||
| Address2: | |||||||||
| City: | TEANECK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076663640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018339500 | ||||||||
| FaxNumber: | 2018620095 | ||||||||
| Practice Location | |||||||||
| Address1: | 663 PALISADE AVE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | CLIFFSIDE PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070103012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019439100 | ||||||||
| FaxNumber: | 2019437308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2010 | ||||||||
| LastUpdateDate: | 12/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 25MA0898200 | NJ | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2081P2900X | 25MA08978200 | NJ | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 2081S0010X | 25MA0898200 | NJ | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine |
No ID Information.