MEDICARE: DR. MOOSA NEJAT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	108760	NY

General Provider Information

NPI Number	:	1972519965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOOSA NEJAT M.D.

Provider Business Mailing Address
First Line	:	25 HARBOUR RD
Second Line	:
City	:	KINGS POINT
State	:	NY
Zip	:	11024-1203
Country	:	US
Telephone Number	:	516-829-6168
Fax Number	:	516-829-4544

Provider Business Practice Location Address
First Line	:	833 NORTHERN BLVD
Second Line	:	SUITE 120
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5315
Country	:	US
Telephone Number	:	516-829-0066
Fax Number	:	516-829-4544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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