Provider Demographics
NPI:1649023789
Name:MOSKOVICS, MORDECHAI
Entity type:Individual
Prefix:
First Name:MORDECHAI
Middle Name:
Last Name:MOSKOVICS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 13TH AVE APT 5R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4588
Mailing Address - Country:US
Mailing Address - Phone:917-653-3278
Mailing Address - Fax:
Practice Address - Street 1:5520 13TH AVE APT 5R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4588
Practice Address - Country:US
Practice Address - Phone:917-653-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist