1457482416 NPI number — DR. ROGER E MOSESSON M.D.

Table of content: DR. ROGER E MOSESSON M.D. (NPI 1457482416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457482416 NPI number — DR. ROGER E MOSESSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSESSON
Provider First Name:
ROGER
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1457482416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 PARK PL
Provider Second Line Business Mailing Address:
GROUND FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10007-2146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-693-1555
Provider Business Mailing Address Fax Number:
212-587-7218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 PARK PL
Provider Second Line Business Practice Location Address:
GROUND FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10007-2146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-693-1555
Provider Business Practice Location Address Fax Number:
212-587-7218
Provider Enumeration Date:
03/08/2007

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: 2085N0700X , with the licence number:  170535 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2085R0202X , with the licence number: 170535 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 743S9 . This is a "EMPIRE BCBS (NY) ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2202221 . This is a "OXFORD ID NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4198779 . This is a "GHI ID NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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