Provider Demographics
NPI:1942220504
Name:MOSHMAN, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MOSHMAN
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 1:59 BEECHDALE RD
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-3001
Mailing Address - Country:US
Mailing Address - Phone:914-693-5020
Mailing Address - Fax:
Practice Address - Street 1:59 BEECHDALE RD
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-3001
Practice Address - Country:US
Practice Address - Phone:914-693-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108107207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00882733Medicaid
NY1282585OtherAETNA HMO
NY2589210OtherGHI PPO
388439OtherMVP
NY5C5708OtherHEALTHNET
MS8107OtherATLANTIS
NY000000103381OtherGHI HMO
NY4457921OtherAETNA PPO
5672423OtherFIRST HEALTH
NY765101OtherEMPIRE BCBS
5672423OtherFIRST HEALTH