Provider Demographics
NPI:1306016969
Name:MOELLER, CHAIM MEIR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAIM
Middle Name:MEIR
Last Name:MOELLER
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 1:12510 QUEENS BLVD
Mailing Address - Street 2:STE 2701
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1519
Mailing Address - Country:US
Mailing Address - Phone:718-261-0444
Mailing Address - Fax:
Practice Address - Street 1:12510 QUEENS BLVD
Practice Address - Street 2:STE 2701
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1519
Practice Address - Country:US
Practice Address - Phone:718-261-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261476207RC0001X, 207RC0001X
OH35.096477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3115711Medicaid
NYG400345222Medicare PIN