Provider Demographics
NPI:1306980941
Name:MOSES, ERIC D (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:MOSES
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 1:1305 WALT WHITMAN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4300
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:321 GENESEE ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2611
Practice Address - Country:US
Practice Address - Phone:315-363-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243990207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
110160500OtherUS DEPT OF LABOR
2405T1OtherEMPIRE BLUE CROSS
AN243990-9WOtherNO FAULT
4158882OtherMVP
000413485001OtherBLUE SHIELD NENY
243990OtherTRICARE
2405T2OtherEMPIRE BLUE CROSS
AN243990-9WOtherWORKERS COMP
000000006183OtherGHI
10126520OtherCDPHP
2405T3OtherEMPIRE BLUE CROSS
RB4707OtherFIDELIS MEDICARE
NY02879743Medicaid
070808000116OtherFIDELIS CARE NY
5301141OtherGHI HMO
RB4707OtherFIDELIS MEDICARE
2405T1OtherEMPIRE BLUE CROSS