Provider Demographics
NPI:1679652036
Name:MOSKOWITZ, ADAM LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:LAWRENCE
Last Name:MOSKOWITZ
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 1:134 HOMER AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1206
Mailing Address - Country:US
Mailing Address - Phone:607-758-8019
Mailing Address - Fax:607-758-8210
Practice Address - Street 1:11 ALVENA AVE STE 105
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1100
Practice Address - Country:US
Practice Address - Phone:607-756-9470
Practice Address - Fax:607-756-7048
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211608207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7956439OtherAETNA
2586471OtherUNITEDHEALTHCARE
NY00246075Medicaid
NY837391Medicare Oscar/Certification
7956439OtherAETNA
NYA300000961Medicare PIN