Healthcare Provider Details

I. General information

NPI: 1447518030
Provider Name (Legal Business Name): DAPHNA MEZAD KOURSH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

75 W END AVE APT P37B
NEW YORK NY
10023-7881
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-9535
  • Fax:
Mailing address:
  • Phone: 646-354-1748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number340790
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: