Healthcare Provider Details

I. General information

NPI: 1396820619
Provider Name (Legal Business Name): SOLOMON L MOSHE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMC - DEPT. OF NEUROLOGY 1515 BLONDELL AVENUE, STE. 220
BRONX NY
10461
US

IV. Provider business mailing address

55 MARCOURT DR
CHAPPAQUA NY
10514-2506
US

V. Phone/Fax

Practice location:
  • Phone: 718-405-8140
  • Fax:
Mailing address:
  • Phone: 718-405-8140
  • Fax: 718-405-8149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number126468
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number126468
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number126468
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: