Provider Demographics
NPI:1457482416
Name:MOSESSON, ROGER E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:E
Last Name:MOSESSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:75 PARK PL
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-2146
Mailing Address - Country:US
Mailing Address - Phone:212-693-1555
Mailing Address - Fax:212-587-7218
Practice Address - Street 1:75 PARK PL
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-2146
Practice Address - Country:US
Practice Address - Phone:212-693-1555
Practice Address - Fax:212-587-7218
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1705352085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY743S9OtherEMPIRE BCBS (NY) ID
NYP2202221OtherOXFORD ID NUMBER
NY4198779OtherGHI ID NUMBER
NY4198779OtherGHI ID NUMBER
NY743S9OtherEMPIRE BCBS (NY) ID