Healthcare Provider Details

I. General information

NPI: 1174689871
Provider Name (Legal Business Name): MICHAEL N MOSKOWITZ DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5415 WEST CEDAR LANE SUITE 105B
BETHESDA MD
20814-1515
US

IV. Provider business mailing address

5415 WEST CEDAR LANE SUITE 105B
BETHESDA MD
20814-1515
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-0802
  • Fax: 301-530-1787
Mailing address:
  • Phone: 301-530-0802
  • Fax: 301-530-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01304
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01304
License Number StateMD

VIII. Authorized Official

Name: DR. MICHAEL NATHAN MOSKOWITZ
Title or Position: PRESIDENT
Credential: DC
Phone: 301-530-0802