Provider Demographics
NPI:1396809745
Name:MOSKOWITZ, DAVID OWEN (CPO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:OWEN
Last Name:MOSKOWITZ
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 RUXTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1317
Mailing Address - Country:US
Mailing Address - Phone:516-742-6328
Mailing Address - Fax:
Practice Address - Street 1:18515 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1731
Practice Address - Country:US
Practice Address - Phone:718-264-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00004700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01063914Medicaid
NY01063914Medicaid