Provider Demographics
NPI:1992704845
Name:MOODY, YASMEEN AHMED (MD)
Entity type:Individual
Prefix:MRS
First Name:YASMEEN
Middle Name:AHMED
Last Name:MOODY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3 RED ROCK RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:845-708-5603
Mailing Address - Fax:607-277-4056
Practice Address - Street 1:3 RED ROCK RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956
Practice Address - Country:US
Practice Address - Phone:845-708-5603
Practice Address - Fax:607-535-4744
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147355208200000X
NY147335-1208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY007L1413Medicaid
NYB82290Medicare UPIN
NY007L1413Medicaid