Healthcare Provider Details

I. General information

NPI: 1275090250
Provider Name (Legal Business Name): MOONES RAJABI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 GRAND CONCOURSE FL 6
BRONX NY
10453-8202
US

IV. Provider business mailing address

1775 GRAND CONCOURSE FL 6
BRONX NY
10453-8202
US

V. Phone/Fax

Practice location:
  • Phone: 718-901-8410
  • Fax:
Mailing address:
  • Phone: 718-901-8410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number063277
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI02945400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: