MEDICARE: STEPHEN MOSES, M.D., LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	020100	CT

General Provider Information

NPI Number	:	1336318989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN MOSES, M.D., LLC

Provider Business Mailing Address
First Line	:	135 DIVISION ST
Second Line	:
City	:	ANSONIA
State	:	CT
Zip	:	06401-2134
Country	:	US
Telephone Number	:	203-735-9354
Fax Number	:	203-732-2106

Provider Business Practice Location Address
First Line	:	135 DIVISION ST
Second Line	:
City	:	ANSONIA
State	:	CT
Zip	:	06401-2134
Country	:	US
Telephone Number	:	203-735-9354
Fax Number	:	203-732-2106

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN J MOSES
Credential	:	M.D.
Telephone Number	:	203-735-9354

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/28/2008

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