Provider Demographics
NPI:1164430070
Name:MOSKOWITZ, LANNY (MD)
Entity Type:Individual
Prefix:DR
First Name:LANNY
Middle Name:
Last Name:MOSKOWITZ
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 1:333 KENNEDY DR
Mailing Address - Street 2:SUITE L104
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3060
Mailing Address - Country:US
Mailing Address - Phone:860-626-1141
Mailing Address - Fax:860-626-8911
Practice Address - Street 1:333 KENNEDY DR
Practice Address - Street 2:SUITE L104
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3060
Practice Address - Country:US
Practice Address - Phone:860-626-1141
Practice Address - Fax:860-626-8911
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027080207Q00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001270800Medicaid
CT027080OtherCIGNA
CT0100270801OtherBCBS
CT0470889OtherAETNA
CT080000185OtherMEDICARE PTAN
CT0470889OtherAETNA