MEDICARE: DR. GOLNAZ MOAZAMI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	203828-1	NY
2	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	203828	NY
3	207WX0109X	Neuro-ophthalmology Physician	203828	NY

General Provider Information

NPI Number	:	1427075407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GOLNAZ MOAZAMI M.D.

Provider Business Mailing Address
First Line	:	700 COLUMBUS AVE FRNT 4
Second Line	:	PWFS BOX 20964
City	:	NEW YORK
State	:	NY
Zip	:	10025-6662
Country	:	US
Telephone Number	:	917-200-8900
Fax Number	:	917-338-5088

Provider Business Practice Location Address
First Line	:	210 E 64TH ST FL 6
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-7471
Country	:	US
Telephone Number	:	917-200-8900
Fax Number	:	917-338-5088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	02/28/2024

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Directions to “ DR. GOLNAZ MOAZAMI M.D.” Practice Location

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