Provider Demographics
NPI:1861541013
Name:MOUSSAVIAN, HAMID (MD)
Entity type:Individual
Prefix:
First Name:HAMID
Middle Name:
Last Name:MOUSSAVIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2367-69 2ND AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3108
Mailing Address - Country:US
Mailing Address - Phone:212-876-2300
Mailing Address - Fax:212-722-7618
Practice Address - Street 1:2367-69 2ND AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035
Practice Address - Country:US
Practice Address - Phone:212-876-2300
Practice Address - Fax:212-722-7618
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1656282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HM087D4810Medicare ID - Type Unspecified