Provider Demographics
NPI:1790886554
Name:BRENDA L. MOSKOVITZ, M.D. PC
Entity Type:Organization
Organization Name:BRENDA L. MOSKOVITZ, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOSKOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:248-524-1001
Mailing Address - Street 1:415 E MAPLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2720
Mailing Address - Country:US
Mailing Address - Phone:248-524-1001
Mailing Address - Fax:248-528-2533
Practice Address - Street 1:415 E MAPLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2720
Practice Address - Country:US
Practice Address - Phone:248-524-1001
Practice Address - Fax:248-528-2533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1606331342OtherBCBS ID#
MIE50126Medicare UPIN
MI1606331342OtherBCBS ID#