Provider Demographics
NPI:1508966565
Name:HAGGAG, MOATAZ YOUSEF (MD)
Entity Type:Individual
Prefix:MR
First Name:MOATAZ
Middle Name:YOUSEF
Last Name:HAGGAG
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 1:110 FIG DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5657
Mailing Address - Country:US
Mailing Address - Phone:516-314-9058
Mailing Address - Fax:631-206-9299
Practice Address - Street 1:240 PATCHOGUE YAPHANK RD
Practice Address - Street 2:SUITE 211
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4868
Practice Address - Country:US
Practice Address - Phone:631-758-2815
Practice Address - Fax:631-206-9299
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FLME1556772084P0800X
NY2274622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02519060Medicaid
NYH46202Medicare UPIN
NY02519060Medicaid