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General NPI Number Information
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NPI Number | 1548443351
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Entity Type | Organization
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Legal Business Name | NEW YORK SPORT & REHABILITATION MEDICINE PC
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Dates
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Enumeration Date | 12/14/2007
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 140 MIDDLE NECK RD
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City | GREAT NECK
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State | NY
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Zip | 11021-1246
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Country | US
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Telephone | 516-829-3399
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Fax | 516-829-9500
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Provider Business Mailing Address
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Address Line | 140 MIDDLE NECK RD
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City | GREAT NECK
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State | NY
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Zip | 11021-1246
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Country | US
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Telephone | 516-829-3399
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Fax | 516-829-9500
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Authorized Official
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Title or Position | OWNER
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Name | KIOOMARS MOOSAZADEH
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Credential | MD
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Telephone | 516-829-3399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 238359
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License Number State | NY
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