Healthcare Provider Details

I. General information

NPI: 1679534580
Provider Name (Legal Business Name): DR. MOSES DATSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2848 CHURCH AVE
BROOKLYN NY
11226-4106
US

IV. Provider business mailing address

253 HARTSHORN DR
SHORT HILLS NJ
07078-1916
US

V. Phone/Fax

Practice location:
  • Phone: 718-284-5500
  • Fax: 718-284-5600
Mailing address:
  • Phone: 718-284-5500
  • Fax: 718-284-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number047288
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: