Provider Demographics
NPI:1356506091
Name:GEORGE MOSKOWITZ MD, PC
Entity Type:Organization
Organization Name:GEORGE MOSKOWITZ MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PC
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-436-2496
Mailing Address - Street 1:1318 42ND STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-1405
Mailing Address - Country:US
Mailing Address - Phone:718-436-2496
Mailing Address - Fax:718-972-5404
Practice Address - Street 1:1318 42ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1405
Practice Address - Country:US
Practice Address - Phone:718-436-2496
Practice Address - Fax:718-972-5404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12409POtherHIP PROVIDER NUMBER
NY03037125OtherMEDICAID GROUP PROVIDER NUMBER
NYD17490OtherMEDICAID UPIN NUMBER
NY123348OtherNEW YORK STATE LICENSE
NY100023441101OtherAMERICHOICE PROVIDER NUMBER
NY123348OtherNEW YORK STATE LICENSE
NY=========OtherTAX ID