Provider Demographics
NPI:1447379896
Name:MOSCOVITZ, BENJAMIN (DPM)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:MOSCOVITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4129
Mailing Address - Country:US
Mailing Address - Phone:718-253-3554
Mailing Address - Fax:
Practice Address - Street 1:572 LOUISIANA AVE # 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-1524
Practice Address - Country:US
Practice Address - Phone:718-253-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003958-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00902112Medicaid
0021599OtherGHI
P40941OtherBLUE SHIELD
P40943OtherBLUE SHIELD
0021599OtherGHI
P40943OtherBLUE SHIELD