Healthcare Provider Details

I. General information

NPI: 1851377394
Provider Name (Legal Business Name): SAM MOSKOWITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 RALPH AVE A2
BROOKLYN NY
11234-5300
US

IV. Provider business mailing address

2035 RALPH AVE A2
BROOKLYN NY
11234-5300
US

V. Phone/Fax

Practice location:
  • Phone: 718-339-2621
  • Fax: 718-377-3598
Mailing address:
  • Phone: 718-339-2621
  • Fax: 718-377-3598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number131584
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: