Healthcare Provider Details

I. General information

NPI: 1043316664
Provider Name (Legal Business Name): MOSHE WAGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W KINGSBRIDGE RD
BRONX NY
10468-3904
US

IV. Provider business mailing address

15 AVON RD
NEW ROCHELLE NY
10804-3302
US

V. Phone/Fax

Practice location:
  • Phone: 171-858-4900
  • Fax:
Mailing address:
  • Phone: 171-858-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberND5182
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: