Provider Demographics
NPI:1104005909
Name:MOSAD, SAFWAT (MD)
Entity type:Individual
Prefix:
First Name:SAFWAT
Middle Name:
Last Name:MOSAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3060
Mailing Address - Country:US
Mailing Address - Phone:631-539-2247
Mailing Address - Fax:631-415-4894
Practice Address - Street 1:20 TIMBER RIDGE DR
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3060
Practice Address - Country:US
Practice Address - Phone:631-539-2247
Practice Address - Fax:631-415-4894
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2025-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246059207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY246059OtherLICENSE