Provider Demographics
NPI:1649404187
Name:MARTIN MOSKOWITZ
Entity Type:Organization
Organization Name:MARTIN MOSKOWITZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-436-1400
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003119152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0902930001Medicare NSC