=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932153541
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOSSAIN MOHSENI D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 09/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2015 GRAND CONCOURSE
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10453-4303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-299-7295
-----------------------------------------------------
Fax | 718-299-6797
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1434 WILLIAMSBRIDGE RD
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10461-2507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-618-0401
-----------------------------------------------------
Fax | 718-795-4394
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | E4568
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 006023
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------