Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 050158 | NY |
NPI | 1073662326 |
---|---|
Provider Name | Dr. Marjan Moghadam |
First Address | New York, NY 10065-7862 |
Second Address | New York, NY 10003-9502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 15/09/2010 |