Healthcare Provider Details

I. General information

NPI: 1003804600
Provider Name (Legal Business Name): STEPHEN J. MOSES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2005
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 DIVISION ST
ANSONIA CT
06401-2134
US

IV. Provider business mailing address

135 DIVISION ST
ANSONIA CT
06401-2134
US

V. Phone/Fax

Practice location:
  • Phone: 203-735-9354
  • Fax: 203-732-2106
Mailing address:
  • Phone: 203-735-9354
  • Fax: 203-732-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number020100
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: