Provider Demographics
NPI:1417138132
Name:MOSHE HAIMOV MD PC
Entity Type:Organization
Organization Name:MOSHE HAIMOV MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:N
Authorized Official - Last Name:HAIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-289-3180
Mailing Address - Street 1:12 E 97TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6918
Mailing Address - Country:US
Mailing Address - Phone:212-289-3180
Mailing Address - Fax:212-289-4814
Practice Address - Street 1:12 E 97TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6918
Practice Address - Country:US
Practice Address - Phone:212-289-3180
Practice Address - Fax:212-289-4814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095458-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW66232Medicare PIN