Provider Demographics
NPI:1215642681
Name:MOSSBERG, YISROEL
Entity type:Individual
Prefix:
First Name:YISROEL
Middle Name:
Last Name:MOSSBERG
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 1:4600 14TH AVE APT 5C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2607
Mailing Address - Country:US
Mailing Address - Phone:347-782-3529
Mailing Address - Fax:
Practice Address - Street 1:4102 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1389
Practice Address - Country:US
Practice Address - Phone:718-400-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker