Provider Demographics
NPI:1790909877
Name:MOSKOWITZ, MARTIN BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:BRUCE
Last Name:MOSKOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:3 SCHOOL ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2548
Mailing Address - Country:US
Mailing Address - Phone:516-676-2878
Mailing Address - Fax:516-674-2256
Practice Address - Street 1:3 SCHOOL ST
Practice Address - Street 2:SUITE 303
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2548
Practice Address - Country:US
Practice Address - Phone:516-676-2878
Practice Address - Fax:516-674-2256
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY176151207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01439330Medicaid
NY70H301Medicare ID - Type Unspecified
NY01439330Medicaid