Provider Demographics
NPI:1962541532
Name:MOSKOWITZ, TAL JORDAN (MD)
Entity type:Individual
Prefix:DR
First Name:TAL
Middle Name:JORDAN
Last Name:MOSKOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3535 PEACHTREE ROAD
Mailing Address - Street 2:SUITE 520 #345
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-3292
Mailing Address - Country:US
Mailing Address - Phone:678-427-4844
Mailing Address - Fax:
Practice Address - Street 1:3535 PEACHTREE ROAD
Practice Address - Street 2:SUITE 520 #345
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-3292
Practice Address - Country:US
Practice Address - Phone:678-427-4844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI375762084N0400X
MI43040809122084N0400X
GA0558422084N0400X
AL175282084N0400X
TXH82692084N0400X
SC221102084N0400X
WI37576-0202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F78822Medicare UPIN
F78827Medicare UPIN
WI019700233Medicare PIN