Healthcare Provider Details

I. General information

NPI: 1821719410
Provider Name (Legal Business Name): HOSSIEN DAHDOULI APN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 LEXINGTON AVE
MOHEGAN LAKE NY
10547-1273
US

IV. Provider business mailing address

1776 WOODSTEAD CT STE 208
THE WOODLANDS TX
77380-1480
US

V. Phone/Fax

Practice location:
  • Phone: 914-528-2000
  • Fax:
Mailing address:
  • Phone: 877-749-7428
  • Fax: 281-724-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ01361600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number310921
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: