Provider Demographics
NPI:1548240666
Name:MOSS, DENNIS STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:STEVEN
Last Name:MOSS
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 1:4 TWINING CT
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3245
Mailing Address - Country:US
Mailing Address - Phone:585-586-6581
Mailing Address - Fax:585-381-6296
Practice Address - Street 1:4 TWINING CT
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3245
Practice Address - Country:US
Practice Address - Phone:585-586-6581
Practice Address - Fax:585-381-6296
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11567512085R0202X
MO321412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1156751OtherWORKERS COMP
NY1173844Medicaid
NY1173844Medicaid
518730Medicare ID - Type Unspecified