Provider Demographics
NPI:1588613228
Name:MOSKOWITZ, MARTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:MOSKOWITZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 47TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2502
Mailing Address - Country:US
Mailing Address - Phone:718-436-1400
Mailing Address - Fax:
Practice Address - Street 1:1201 47TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2502
Practice Address - Country:US
Practice Address - Phone:718-436-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003119152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC25541Medicare PIN
NYT48922Medicare UPIN
NY0902930001Medicare NSC