Provider Demographics
NPI:1700942521
Name:MOQTADERI, FARIDEH (MD)
Entity Type:Individual
Prefix:DR
First Name:FARIDEH
Middle Name:
Last Name:MOQTADERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E 72 STREET
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4852
Mailing Address - Country:US
Mailing Address - Phone:212-426-9200
Mailing Address - Fax:212-860-2425
Practice Address - Street 1:520 E 72 STREET
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4852
Practice Address - Country:US
Practice Address - Phone:212-426-9200
Practice Address - Fax:212-860-2425
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1176861207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
330951Medicare ID - Type Unspecified
B13166Medicare UPIN