Organization
FAZLOLLAH FRAYDOON MOQTADERI PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FAZLOLLAH FRAYDOON MOQTADERI MD (PRESIDENT)
(212) 876-2322
Entity
Organization
Contact information
Practice address
520 E 72 STREET, SUITE 1C, NEW YORK, NY 10021-4852
(212) 876-2322
(212) 860-2425
Mailing address
520 E 72 STREET, SUITE 1C, NEW YORK, NY 10021-4852
(212) 876-2322
(212) 860-2425
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
1176921
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004928
PHS
—
01
—
0095588
GHI
—
01
—
898073
EMPIRE BLUE SHIELD
—
01
—
N61821
HEALTHNET
—
01
—
NS1914
OXFORD
—
Enumeration date
01/31/2007
Last updated
08/22/2020
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