Healthcare Provider Details

I. General information

NPI: 1679578496
Provider Name (Legal Business Name): ROBERT M. MOSKOWITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 POST RD
FAIRFIELD CT
06824-6016
US

IV. Provider business mailing address

1305 POST RD
FAIRFIELD CT
06824-6016
US

V. Phone/Fax

Practice location:
  • Phone: 203-292-2000
  • Fax: 203-255-5212
Mailing address:
  • Phone: 203-292-2000
  • Fax: 203-255-5212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number042586
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: