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General NPI Number Information
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NPI Number | 1164616116
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Entity Type | Organization
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Legal Business Name | AHAMED S MOIDEEN MD PC
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 09/28/2007
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Provider Practice Location Address
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Address Line | 142 04 BAYSIDE AVE STE 5L
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City | FLUSHING
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State | NY
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Zip | 11354-2331
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Country | US
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Telephone | 718-359-8346
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Fax | 718-359-8342
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Provider Business Mailing Address
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Address Line | 142 04 BAYSIDE AVE STE 5L
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City | FLUSHING.
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State | NY
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Zip | 11354-2331
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Country | US
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Telephone | 718-359-8346
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Fax | 718-359-8342
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Authorized Official
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Title or Position | PRESIDENT
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Name | AHAMED S MOIDEEN
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Credential | MD FACS FCCP RPVI
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Telephone | 718-359-8346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 132106
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 132106
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License Number State | NY
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