Healthcare Provider Details

I. General information

NPI: 1407092976
Provider Name (Legal Business Name): MORRIS MOSSERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 TSHERMICHOVSKY STREET
KFIAR-SAVA IL
44281
IL

IV. Provider business mailing address

1 SHTREIHMAN STREET
TEL AVIV IL
69671
IL

V. Phone/Fax

Practice location:
  • Phone: 729-747-2587
  • Fax:
Mailing address:
  • Phone: 729-747-2587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number74950
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: