Provider Demographics
NPI:1093807919
Name:MOSSMAN, HARVEY ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:ARTHUR
Last Name:MOSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 MINEOLA BLVD.
Mailing Address - Street 2:SUITE 403
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2555
Mailing Address - Country:US
Mailing Address - Phone:516-741-8891
Mailing Address - Fax:516-741-8829
Practice Address - Street 1:173 MINEOLA BLVD
Practice Address - Street 2:SUITE 403
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2528
Practice Address - Country:US
Practice Address - Phone:516-741-8891
Practice Address - Fax:516-741-8829
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A64950Medicare UPIN
NYA400143126Medicare PIN