Provider Demographics
NPI:1598742637
Name:MORADI, ISSAC ESHAGH (MD)
Entity Type:Individual
Prefix:
First Name:ISSAC
Middle Name:ESHAGH
Last Name:MORADI
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 1:2221 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-9005
Mailing Address - Country:US
Mailing Address - Phone:718-798-3030
Mailing Address - Fax:718-519-0603
Practice Address - Street 1:2221 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-9005
Practice Address - Country:US
Practice Address - Phone:718-798-3030
Practice Address - Fax:718-519-0603
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208978207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2407367Medicaid
NY446B21Medicare ID - Type Unspecified
NYH20248Medicare UPIN