Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 196882 | NY |
NPI | 1043377237 |
---|---|
Provider Name | Mark M Moradi |
First Address | East Hills, NY 11577 |
Second Address | Fresh Meadows, NY 11366-1255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 25/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C78931 | (02) |