Provider Demographics
NPI:1205102225
Name:JAZAYERI-MOGHADASS, BABAK SEYED (MD)
Entity type:Individual
Prefix:DR
First Name:BABAK
Middle Name:SEYED
Last Name:JAZAYERI-MOGHADASS
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 1:7852 85TH ST
Mailing Address - Street 2:APT# 2
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7615
Mailing Address - Country:US
Mailing Address - Phone:301-452-5177
Mailing Address - Fax:
Practice Address - Street 1:24 MAIN ST
Practice Address - Street 2:APT# 2C
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-2121
Practice Address - Country:US
Practice Address - Phone:301-452-5177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285304207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine