Moallem, Anita Gross

Moallem, Anita Gross is an individual health care provider with primary practice located at 4355 147Th St , Flushing NY 11355-1736. She recently has only one registered license in Other Service Providers / Specialist, which is considered as her primary health care specialty. Moallem, Anita Gross can be contacted via phone (718) 762-0900.

Contact Information

Primary practice address
4355 147Th St Flushing NY 11355-1736
Phone: (718) 762-0900
Fax: (718) 886-5659
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 095345 New York

Profile Details

NPI number 1932146339
LBN Legal business name Moallem, Anita Gross
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 2nd, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932146339 NPPES
New York Other 10459014 CAQH
New York MEDICAID 00549293 CAQH

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