Provider Demographics
NPI:1841245149
Name:ARBABZADEH, MASSOUD (MD)
Entity Type:Individual
Prefix:DR
First Name:MASSOUD
Middle Name:
Last Name:ARBABZADEH
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 1:40 VALLEY STREAM PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1407
Mailing Address - Country:US
Mailing Address - Phone:610-644-8900
Mailing Address - Fax:484-924-0053
Practice Address - Street 1:1225 MCBRIDE AVE STE 117
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-3813
Practice Address - Country:US
Practice Address - Phone:973-837-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1413542085R0204X
NY2558002085R0204X
AZ62507208D00000X
NY0018412085R0204X
CAC1713312085R0204X
NJ25MA104762002085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02428866Medicaid
000527365001OtherBLUE SHIELD OF WESTERN NY
P00047810OtherRAILROAD MEDICARE
1611705OtherINDEPENDANT HEALTH
255800OtherNY LICENSE
00026468801OtherUNIVERA
00026468802OtherUNIVERA
P00047810OtherRAILROAD MEDICARE
000527365001OtherBLUE SHIELD OF WESTERN NY