MEDICARE: SAM MOSKOWITZ MD

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	207RG0100X	Gastroenterology Physician	131584	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851377394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAM MOSKOWITZ MD

Provider Business Mailing Address
First Line	:	2035 RALPH AVE
Second Line	:	A2
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5300
Country	:	US
Telephone Number	:	718-339-2621
Fax Number	:	718-377-3598

Provider Business Practice Location Address
First Line	:	2035 RALPH AVE
Second Line	:	A2
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5300
Country	:	US
Telephone Number	:	718-339-2621
Fax Number	:	718-377-3598

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	06/10/2011

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