Provider Demographics
NPI:1467560722
Name:MOUALLEM, HAMID Y (MD)
Entity Type:Individual
Prefix:
First Name:HAMID
Middle Name:Y
Last Name:MOUALLEM
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 1:200 CENTRAL PARK SOUTH
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-765-6322
Mailing Address - Fax:212-757-7732
Practice Address - Street 1:200 CENTRAL PARK SOUTH
Practice Address - Street 2:SUITE 210
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-765-6322
Practice Address - Fax:212-757-7732
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101161207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00173919Medicaid
NY00173919Medicaid
B15519Medicare UPIN