Healthcare Provider Details

I. General information

NPI: 1306036744
Provider Name (Legal Business Name): ROBERT IRWIN MOSKOWITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MANSFIELD AVE
WILLIMANTIC CT
06226-2018
US

IV. Provider business mailing address

40 MANSFIELD AVE
WILLIMANTIC CT
06226-2018
US

V. Phone/Fax

Practice location:
  • Phone: 860-450-7471
  • Fax: 860-450-0213
Mailing address:
  • Phone: 860-450-7471
  • Fax: 860-450-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number015621
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: