Provider Demographics
NPI:1609234608
Name:MOSKOWITZ DERMATOLOGY M.D., P.L.L.C
Entity Type:Organization
Organization Name:MOSKOWITZ DERMATOLOGY M.D., P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOSKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-542-0100
Mailing Address - Street 1:1000 W BROADWAY ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9260
Mailing Address - Country:US
Mailing Address - Phone:407-542-0100
Mailing Address - Fax:407-992-7701
Practice Address - Street 1:1000 W BROADWAY ST
Practice Address - Street 2:SUITE 206
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9260
Practice Address - Country:US
Practice Address - Phone:407-542-0100
Practice Address - Fax:407-992-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79584207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258625800Medicaid
FLH13997Medicare UPIN