Provider Demographics
NPI:1447335351
Name:MOIN, SYED (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:
Last Name:MOIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 N PLANK RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-8858
Mailing Address - Country:US
Mailing Address - Phone:845-728-2655
Mailing Address - Fax:845-496-1396
Practice Address - Street 1:312 N PLANK RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-8858
Practice Address - Country:US
Practice Address - Phone:845-728-2655
Practice Address - Fax:845-496-1396
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167508207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01152469Medicaid
NYE45028Medicare UPIN
NY01152469Medicaid