Healthcare Provider Details

I. General information

NPI: 1861541013
Provider Name (Legal Business Name): HAMID MOUSSAVIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2367-69 2ND AVE 1ST FLOOR
NEW YORK NY
10035
US

IV. Provider business mailing address

2367-69 2ND AVE 1ST FLOOR
NEW YORK NY
10035-3108
US

V. Phone/Fax

Practice location:
  • Phone: 212-876-2300
  • Fax: 212-722-7618
Mailing address:
  • Phone: 212-876-2300
  • Fax: 212-722-7618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number165628
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: