Healthcare Provider Details

I. General information

NPI: 1558080242
Provider Name (Legal Business Name): DR. ZORAIZE MOEEZ ATHAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 N BROAD ST # A
PHILADELPHIA PA
19140-4106
US

IV. Provider business mailing address

1650 GRAND CONCOURSE
BRONX NY
10457-7679
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-7198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD488577
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: