Healthcare Provider Details

I. General information

NPI: 1548980709
Provider Name (Legal Business Name): MILAD PARSA MOQADAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457-7697
US

IV. Provider business mailing address

2175 QUARRY RD
BRONX NY
10457-1663
US

V. Phone/Fax

Practice location:
  • Phone: 718-590-1800
  • Fax:
Mailing address:
  • Phone: 718-960-3917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number346000
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: