Healthcare Provider Details

I. General information

NPI: 1215980628
Provider Name (Legal Business Name): BONNIE C MOSKOWITZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 OAKHURST CIR
KISSIMMEE FL
34744-4752
US

IV. Provider business mailing address

246 OAKHURST CIR
KISSIMMEE FL
34744-4752
US

V. Phone/Fax

Practice location:
  • Phone: 754-702-7256
  • Fax:
Mailing address:
  • Phone: 754-702-7256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036111638
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036111638
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: