Provider Demographics
NPI:1427147750
Name:MOAZEN, HALEH (MD)
Entity type:Individual
Prefix:
First Name:HALEH
Middle Name:
Last Name:MOAZEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 EAST 210TH STREET,
Mailing Address - Street 2:SILVER ZONE,6TH FLOOR N6A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:718-920-4444
Mailing Address - Fax:718-320-8857
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:SILVER ZONE,6TH FLOOR N6A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-4444
Practice Address - Fax:718-320-8857
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198396207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine