Provider Demographics
NPI:1972519965
Name:NEJAT, MOOSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MOOSA
Middle Name:
Last Name:NEJAT
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 1:25 HARBOUR RD
Mailing Address - Street 2:
Mailing Address - City:KINGS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1203
Mailing Address - Country:US
Mailing Address - Phone:516-829-6168
Mailing Address - Fax:516-829-4544
Practice Address - Street 1:833 NORTHERN BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5315
Practice Address - Country:US
Practice Address - Phone:516-829-0066
Practice Address - Fax:516-829-4544
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108760174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB18357Medicare UPIN