Provider Demographics
NPI:1619018884
Name:NOSSOUGHI, AKBAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:AKBAR
Middle Name:A
Last Name:NOSSOUGHI
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 1:152 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4710
Mailing Address - Country:US
Mailing Address - Phone:845-357-5490
Mailing Address - Fax:845-357-4465
Practice Address - Street 1:152 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4710
Practice Address - Country:US
Practice Address - Phone:845-357-5490
Practice Address - Fax:845-357-4465
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095530-1207Y00000X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Not Answered207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB14156Medicare UPIN
NY382051Medicare ID - Type Unspecified