Provider Demographics
NPI:1982667549
Name:MOIDEEN, AHAMED S (MD,FACS,FCCP,RPVI)
Entity Type:Individual
Prefix:
First Name:AHAMED
Middle Name:S
Last Name:MOIDEEN
Suffix:
Gender:M
Credentials:MD,FACS,FCCP,RPVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:80 MARCUS DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4230
Mailing Address - Country:US
Mailing Address - Phone:631-391-8366
Mailing Address - Fax:631-454-4163
Practice Address - Street 1:14601 45TH AVE
Practice Address - Street 2:STE 406
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-670-5473
Practice Address - Fax:718-670-4569
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1321062086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00612253Medicaid
NY00612253Medicaid
C66964Medicare UPIN