Healthcare Provider Details

I. General information

NPI: 1487564290
Provider Name (Legal Business Name): GHIZLANE MOUSSAOUI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E 76TH ST APT 2F
NEW YORK NY
10021-2514
US

IV. Provider business mailing address

425 E 76TH ST APT 2F
NEW YORK NY
10021-2514
US

V. Phone/Fax

Practice location:
  • Phone: 646-531-4278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number341041
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: