Active NPI
Khosrow G Moghaddam
- Pharmacist
- Hollis, NY
National Provider Identifier
1295903474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 037245
- Practice address
- 20419 Hillside Ave
Hollis, NY 11423-2213 - Phone
- (718) 465-2121
- NPI assigned
- Feb 11, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 037245 | NY | Primary |
Addresses
Primary practice location
20419 Hillside Ave
Hollis, NY 11423-2213
Mailing address
22 Foxwood Rd
Kings Point, NY 11024-1202
Phone (516) 829-2976
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 037245 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202688000000",
"number": "1295903474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 FOXWOOD RD",
"city": "KINGS POINT",
"state": "NY",
"postal_code": "110241202",
"telephone_number": "516-829-2976"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20419 HILLSIDE AVE",
"city": "HOLLIS",
"state": "NY",
"postal_code": "114232213",
"telephone_number": "718-465-2121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOGHADDAM",
"first_name": "KHOSROW",
"middle_name": "G",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-11",
"last_updated": "2008-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "037245",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hollis, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.