1013082130 NPI number — JOEL MOSES MD PLLC

Table of content: (NPI 1013082130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013082130 NPI number — JOEL MOSES MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOEL MOSES MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INFECTIOUS DISEASES OF EASTERN ALBANY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013082130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 NORTHERN BLVD
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12204-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-462-9675
Provider Business Mailing Address Fax Number:
518-729-3444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 NORTHERN BLVD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12204-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-462-9675
Provider Business Practice Location Address Fax Number:
518-729-3444
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOSES
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
518-462-9675

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  185876 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01490606 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 185876-OW . This is a "WORKERS COMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 362538 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00062301 . This is a "RR MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2X4191 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000403783002 . This is a "BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: DD4915 . This is a "MEDICAID ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10071123 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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