Individual
FARZAD MODARESS MOUSSAVI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
40 E MAIN ST, BAY SHORE, NY 11706-8301
(631) 376-6075
(631) 376-6091
Mailing address
40 E MAIN ST, BAY SHORE, NY 11706-8301
(631) 376-6075
(631) 376-6091
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD041637
DC
208M00000X
Hospitalist Physician
MD041637
DC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/14/2011
Last updated
12/08/2021
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