Provider Demographics
NPI:1851300826
Name:MOSSERI, MAURICE (MD)
Entity Type:Individual
Prefix:MR
First Name:MAURICE
Middle Name:
Last Name:MOSSERI
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 1:2148 OCEAN AVE
Mailing Address - Street 2:STE 603
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1406
Mailing Address - Country:US
Mailing Address - Phone:718-339-5100
Mailing Address - Fax:718-339-2648
Practice Address - Street 1:2148 OCEAN AVE
Practice Address - Street 2:STE 603
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1406
Practice Address - Country:US
Practice Address - Phone:718-339-5100
Practice Address - Fax:718-339-2648
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189443207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01707120Medicaid
NY4648632691Medicare PIN
NYG38673Medicare UPIN
NY01707120Medicaid
A400019856Medicare PIN
NY464862Medicare PIN
NY04809JMedicare PIN