Provider Demographics
NPI:1548216500
Name:MOAZEN, ALI (DPM)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:MOAZEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WATER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0010
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:260 W SUNRISE HWY STE 200
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1015
Practice Address - Country:US
Practice Address - Phone:516-825-3600
Practice Address - Fax:516-872-5137
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005024213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU43160Medicare UPIN
NYP60411Medicare ID - Type Unspecified