Healthcare Provider Details

I. General information

NPI: 1821141276
Provider Name (Legal Business Name): EHUD MOSCOVITZ MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 W LISBON AVE SUITE 102
MILWAUKEE WI
53210-2116
US

IV. Provider business mailing address

4858 N LARKIN ST
MILWAUKEE WI
53217-6042
US

V. Phone/Fax

Practice location:
  • Phone: 414-871-9111
  • Fax: 414-871-9121
Mailing address:
  • Phone: 414-963-1449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: