Healthcare Provider Details

I. General information

NPI: 1588305429
Provider Name (Legal Business Name): MURRIAM MASOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

355 BARD AVENUE DEPARTMENT OF MEDICINE VILLA BLDG 1ST FLOOR
STATEN ISLAND NY
10310
US

V. Phone/Fax

Practice location:
  • Phone: 929-542-7963
  • Fax:
Mailing address:
  • Phone: 718-818-2419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036176407
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: