Provider Demographics
NPI:1225218175
Name:MOSCOW MEDICAL P.C.
Entity type:Organization
Organization Name:MOSCOW MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-992-0912
Mailing Address - Street 1:950 70TH ST
Mailing Address - Street 2:SUITE# 3A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1100
Mailing Address - Country:US
Mailing Address - Phone:917-992-0912
Mailing Address - Fax:
Practice Address - Street 1:950 70TH ST
Practice Address - Street 2:SUITE# 3A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1100
Practice Address - Country:US
Practice Address - Phone:917-992-0912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214541207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWYRTP1Medicare PIN