Healthcare Provider Details

I. General information

NPI: 1528064565
Provider Name (Legal Business Name): RONALD MOSKOVICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 17TH ST
NEW YORK NY
10003-3804
US

IV. Provider business mailing address

301 E 17TH ST
NEW YORK NY
10003-3804
US

V. Phone/Fax

Practice location:
  • Phone: 212-598-6622
  • Fax: 212-598-6291
Mailing address:
  • Phone: 212-598-6622
  • Fax: 212-598-6291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number161969-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: