Provider Demographics
NPI:1164616116
Name:AHAMED S MOIDEEN MD PC
Entity Type:Organization
Organization Name:AHAMED S MOIDEEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHAMED
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOIDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS FCCP RPVI
Authorized Official - Phone:718-359-8346
Mailing Address - Street 1:142 04 BAYSIDE AVE
Mailing Address - Street 2:STE 5L
Mailing Address - City:FLUSHING.
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2331
Mailing Address - Country:US
Mailing Address - Phone:718-359-8346
Mailing Address - Fax:718-359-8342
Practice Address - Street 1:142 04 BAYSIDE AVE
Practice Address - Street 2:STE 5L
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2331
Practice Address - Country:US
Practice Address - Phone:718-359-8346
Practice Address - Fax:718-359-8342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1321062086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00612253Medicaid
C66964Medicare UPIN