Provider Demographics
NPI:1720678568
Name:GOLNAZ MOAZAMI MD
Entity Type:Organization
Organization Name:GOLNAZ MOAZAMI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GOLNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MOAZAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-305-3276
Mailing Address - Street 1:700 COLUMBUS AVE FRNT 4
Mailing Address - Street 2:PWFS BOX 20964
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6662
Mailing Address - Country:US
Mailing Address - Phone:917-200-8900
Mailing Address - Fax:917-338-5088
Practice Address - Street 1:635 W 165TH ST STE 304
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3724
Practice Address - Country:US
Practice Address - Phone:212-305-3272
Practice Address - Fax:646-317-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmologyGroup - Single Specialty