MEDICARE: JOEL M. MOSKOWITZ D.M.D.

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	1223G0001X	General Practice Dentistry	22DI00977800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22DI00977800	OTHER	NJ	DENTAL LICENSE

General Provider Information

NPI Number	:	1568478089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL M. MOSKOWITZ D.M.D.

Provider Business Mailing Address
First Line	:	28 BOWLING GREEN PKWY
Second Line	:
City	:	LAKE HOPATCONG
State	:	NJ
Zip	:	07849-2445
Country	:	US
Telephone Number	:	973-663-4220
Fax Number	:	973-663-6136

Provider Business Practice Location Address
First Line	:	28 BOWLING GREEN PKWY
Second Line	:
City	:	LAKE HOPATCONG
State	:	NJ
Zip	:	07849-2445
Country	:	US
Telephone Number	:	973-663-4220
Fax Number	:	973-663-6136

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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