Provider Demographics
NPI:1093724528
Name:SCHUCK, MOSHE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOSHE
Middle Name:
Last Name:SCHUCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 JERUSALEM AVE
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5533
Mailing Address - Country:US
Mailing Address - Phone:516-931-8899
Mailing Address - Fax:516-931-3666
Practice Address - Street 1:400 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5533
Practice Address - Country:US
Practice Address - Phone:516-931-8899
Practice Address - Fax:516-931-3666
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0512411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice