Healthcare Provider Details

I. General information

NPI: 1619552668
Provider Name (Legal Business Name): SYED AHMAD MOOSA MBBS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2054
US

IV. Provider business mailing address

451 CLARKSON AVE
BROOKLYN NY
11203-2054
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-3364
  • Fax: 860-300-3458
Mailing address:
  • Phone: 718-245-3364
  • Fax: 860-300-3458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MA12651800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number331509
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: