Provider Demographics
NPI:1194901660
Name:KENNETH MOSKOWITZ DPM
Entity type:Organization
Organization Name:KENNETH MOSKOWITZ DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-795-2158
Mailing Address - Street 1:600 W 161ST ST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-5609
Mailing Address - Country:US
Mailing Address - Phone:212-795-2158
Mailing Address - Fax:718-217-1203
Practice Address - Street 1:600 W 161ST ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-5609
Practice Address - Country:US
Practice Address - Phone:212-795-2158
Practice Address - Fax:718-217-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0024401332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4989810002Medicare NSC