1548216500 NPI number — ALI MOAZEN DPM

Table of content: ALI MOAZEN DPM (NPI 1548216500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548216500 NPI number — ALI MOAZEN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOAZEN
Provider First Name:
ALI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548216500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ADVANTAGECARE PHYSICIANS, PC
Provider Second Line Business Mailing Address:
55 WATER STREET 2ND FLOOR CRED DEPT
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10041-0004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-680-1433
Provider Business Mailing Address Fax Number:
516-542-5556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
226 CLINTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEMPSTEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11550-2614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-483-2020
Provider Business Practice Location Address Fax Number:
516-560-1855
Provider Enumeration Date:
05/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  N005024 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)