Provider Demographics
NPI:1477661205
Name:MOSES, JOEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:E
Last Name:MOSES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 ROSEHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-4625
Mailing Address - Country:US
Mailing Address - Phone:518-421-2255
Mailing Address - Fax:
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1899
Practice Address - Country:US
Practice Address - Phone:315-448-6253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185876-1207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000403783002OtherBLUE SHIELD BLUE CROSS
NY362538OtherMVP
NYP00062301OtherRR MEDICARE
NY01490606Medicaid
NY185876-OWOtherWORKERS COMP
NY10071123OtherCDPHP
NY185876-OWOtherWORKERS COMP
NY362538OtherMVP