Healthcare Provider Details

I. General information

NPI: 1508909805
Provider Name (Legal Business Name): WOMENS CANCER CARE OF NEW YORK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16416 76TH RD SECOND FLOOR
FRESH MEADOWS NY
11366-1255
US

IV. Provider business mailing address

265 REVERE RD
ROSLYN HEIGHTS NY
11577-1629
US

V. Phone/Fax

Practice location:
  • Phone: 718-380-8080
  • Fax: 718-380-7649
Mailing address:
  • Phone: 718-380-8080
  • Fax: 718-380-7649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK M MORADI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-380-8080