Basic Information
| Provider Information | |||||||||
| NPI: | 1992704845 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOODY | ||||||||
| FirstName: | YASMEEN | ||||||||
| MiddleName: | AHMED | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 RED ROCK RD | ||||||||
| Address2: | |||||||||
| City: | NEW CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457085603 | ||||||||
| FaxNumber: | 6072774056 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 RED ROCK RD | ||||||||
| Address2: | |||||||||
| City: | NEW CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457085603 | ||||||||
| FaxNumber: | 6075354744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2005 | ||||||||
| LastUpdateDate: | 03/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 147355 | NY | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 208200000X | 147335-1 | NY | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 007L1413 | 05 | NY | MEDICAID |