Provider Demographics
NPI:1598783706
Name:MOSKOW, ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:MOSKOW
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 1:111 BROADWAY
Mailing Address - Street 2:#1005
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1951
Mailing Address - Country:US
Mailing Address - Phone:646-217-4610
Mailing Address - Fax:917-591-8596
Practice Address - Street 1:88-10 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3842
Practice Address - Country:US
Practice Address - Phone:718-291-8111
Practice Address - Fax:718-487-9343
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83128207R00000X
NY163293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01157060Medicaid
NY01157060Medicaid
FLD02601Medicare UPIN