1306980941 NPI number — DR. ERIC D MOSES MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306980941 NPI number — DR. ERIC D MOSES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSES
Provider First Name:
ERIC
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1306980941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 WALT WHITMAN RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11747-4300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-945-3000
Provider Business Mailing Address Fax Number:
516-945-3131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 GENESEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONEIDA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13421-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-363-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  243990 , 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: 110160500 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2405T1 . This is a "EMPIRE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: AN243990-9W . This is a "NO FAULT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4158882 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000413485001 . This is a "BLUE SHIELD NENY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 243990 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2405T2 . This is a "EMPIRE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: AN243990-9W . This is a "WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000006183 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10126520 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2405T3 . This is a "EMPIRE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: RB4707 . This is a "FIDELIS MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02879743 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 070808000116 . This is a "FIDELIS CARE NY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5301141 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".




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