Provider Demographics
NPI:1821538349
Name:MOSKOWITZ, MICHAEL LEE (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:MOSKOWITZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E 38TH ST
Mailing Address - Street 2:3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2705
Mailing Address - Country:US
Mailing Address - Phone:516-554-7975
Mailing Address - Fax:
Practice Address - Street 1:30 BROAD ST
Practice Address - Street 2:SUITE 2005
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2304
Practice Address - Country:US
Practice Address - Phone:212-792-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist