Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 183019-1 | NY |
NPI | 1013992494 |
---|---|
Provider Name | Dr. Hamid Jack Moallem |
First Address | Brooklyn, NY 11203-2056 |
Second Address | Brooklyn, NY 11203-2056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 27/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01422884 | (05) | NY |