Provider Demographics
NPI:1790069730
Name:MOSSLEHI, MOHSEN (DC)
Entity Type:Individual
Prefix:
First Name:MOHSEN
Middle Name:
Last Name:MOSSLEHI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 PROSPECT AVE
Mailing Address - Street 2:APT. 611
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2511
Mailing Address - Country:US
Mailing Address - Phone:201-888-2688
Mailing Address - Fax:
Practice Address - Street 1:9205 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-2428
Practice Address - Country:US
Practice Address - Phone:201-888-2688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor