Healthcare Provider Details

I. General information

NPI: 1720678568
Provider Name (Legal Business Name): GOLNAZ MOAZAMI MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 W 165TH ST STE 304
NEW YORK NY
10032-3724
US

IV. Provider business mailing address

700 COLUMBUS AVE FRNT 4 PWFS BOX 20964
NEW YORK NY
10025-6662
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-3272
  • Fax: 646-317-5751
Mailing address:
  • Phone: 917-200-8900
  • Fax: 917-338-5088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GOLNAZ MOAZAMI
Title or Position: OWNER
Credential: MD
Phone: 212-305-3276