Healthcare Provider Details

I. General information

NPI: 1598742637
Provider Name (Legal Business Name): ISSAC ESHAGH MORADI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 BOSTON RD
BRONX NY
10467-9005
US

IV. Provider business mailing address

2221 BOSTON RD
BRONX NY
10467-9005
US

V. Phone/Fax

Practice location:
  • Phone: 718-798-3030
  • Fax: 718-519-0603
Mailing address:
  • Phone: 718-798-3030
  • Fax: 718-519-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number208978
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: