MEDICARE: DR. LEO MOSKOWITZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	026775	NY

General Provider Information

NPI Number	:	1326029224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEO MOSKOWITZ DDS

Provider Business Mailing Address
First Line	:	14 URSULA DR
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-3019
Country	:	US
Telephone Number	:	516-484-2384
Fax Number	:	516-484-2384

Provider Business Practice Location Address
First Line	:	21518 HILLSIDE AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-1810
Country	:	US
Telephone Number	:	718-464-2891
Fax Number	:	718-264-3289

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	07/08/2007

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