Provider Demographics
NPI:1851398895
Name:MOSKOWITZ-ELFENBEIN, LESLIE B (MD)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:B
Last Name:MOSKOWITZ-ELFENBEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:B
Other - Last Name:MOSKOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:711 N TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2243
Mailing Address - Country:US
Mailing Address - Phone:970-641-1456
Mailing Address - Fax:970-641-4461
Practice Address - Street 1:711 N TAYLOR ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230
Practice Address - Country:US
Practice Address - Phone:970-641-1456
Practice Address - Fax:970-641-4461
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0057302207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01971324Medicaid
NY180038935Medicare PIN
NY01971324Medicaid
452621Medicare ID - Type Unspecified
H13253Medicare UPIN