Healthcare Provider Details

I. General information

NPI: 1790886554
Provider Name (Legal Business Name): BRENDA L. MOSKOVITZ, M.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E MAPLE RD SUITE 101
TROY MI
48083-2720
US

IV. Provider business mailing address

415 E MAPLE RD SUITE 101
TROY MI
48083-2720
US

V. Phone/Fax

Practice location:
  • Phone: 248-524-1001
  • Fax: 248-528-2533
Mailing address:
  • Phone: 248-524-1001
  • Fax: 248-528-2533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENDA L. MOSKOVITZ
Title or Position: DR.
Credential: M.D. PC
Phone: 248-524-1001