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General NPI Number Information
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NPI Number | 1972519965
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Entity Type | Individual
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Provider Name | MOOSA NEJAT M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 833 NORTHERN BLVD SUITE 120
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City | GREAT NECK
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State | NY
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Zip | 11021-5315
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Country | US
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Telephone | 516-829-0066
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Fax | 516-829-4544
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Provider Business Mailing Address
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Address Line | 25 HARBOUR RD
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City | KINGS POINT
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State | NY
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Zip | 11024-1203
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Country | US
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Telephone | 516-829-6168
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Fax | 516-829-4544
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 108760
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License Number State | NY
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