Fazlollah Fraydoon Moqtaderi PC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

1176921 Issued in NY

Legal business name

FAZLOLLAH FRAYDOON MOQTADERI PC

Practice address

520 E 72 Street
Suite 1C
New York, NY 10021-4852

Phone

(212) 876-2322

Fax

(212) 860-2425

NPI assigned

Jan 31, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Fazlollah Fraydoon Moqtaderi, MD

Title

President

Phone

(212) 876-2322

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fazlollah Fraydoon Mogtaderi, MD

  • Surgery Physician
  • New York, NY
  • NPI 1831254861
  NPD (past)
• Farideh Moqtaderi, MD

  • Anesthesiology Physician
  • New York, NY
  • NPI 1700942521
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689711673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 E 72 STREET",
            "address_2": "SUITE 1C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214852",
            "telephone_number": "212-876-2322",
            "fax_number": "212-860-2425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 E 72 STREET",
            "address_2": "SUITE 1C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214852",
            "telephone_number": "212-876-2322",
            "fax_number": "212-860-2425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAZLOLLAH FRAYDOON MOQTADERI PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOQTADERI",
        "authorized_official_first_name": "FAZLOLLAH",
        "authorized_official_middle_name": "FRAYDOON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-876-2322",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "NY",
            "license": "1176921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BLUE SHIELD",
            "identifier": "898073",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "0095588",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "NS1914",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHS",
            "identifier": "004928",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "N61821",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hanna Fazio, LMSW
• Irina Kotovsky Fazio, O.D.
• Kim M Fazio, LPN
• Taylor Marie Fazio
• Jessamine Fazli-Ahmed, MD
• Jonathan Fazylov
• Roman Fazylov, PHARM.D.
• Roberta Fazylova
• Violetta Fazylova
• David A Fazzari, PH.D.

• Surgery Physician in New York, NY
• Providers in New York, NY by specialty
• Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.