Individual
DR. FAZLOLLAH FRAYDOON MOGTADERI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
520 E 72 STREET, SUTIE 1C, NEW YORK, NY 10021-4852
(212) 876-2322
(212) 860-2425
Mailing address
520 E 72 STREET, SUTIE 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
12/27/2006
Last updated
07/08/2007
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