Provider Demographics
NPI:1790751402
Name:MOSBERG, HERBERT J (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:J
Last Name:MOSBERG
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:PO BOX 27842
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7842
Mailing Address - Country:US
Mailing Address - Phone:718-670-1651
Mailing Address - Fax:718-740-1551
Practice Address - Street 1:18904 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1938
Practice Address - Country:US
Practice Address - Phone:718-740-5545
Practice Address - Fax:718-740-1551
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109340207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00241901Medicaid
NY00241901Medicaid
NY02433GMedicare ID - Type Unspecified
NYP00429950Medicare PIN