Provider Demographics
NPI:1326029224
Name:MOSKOWITZ, LEO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:
Last Name:MOSKOWITZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 URSULA DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3019
Mailing Address - Country:US
Mailing Address - Phone:516-484-2384
Mailing Address - Fax:516-484-2384
Practice Address - Street 1:21518 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-1810
Practice Address - Country:US
Practice Address - Phone:718-464-2891
Practice Address - Fax:718-264-3289
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026775122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist