Provider Demographics
NPI:1174689871
Name:MICHAEL N MOSKOWITZ DC PA
Entity type:Organization
Organization Name:MICHAEL N MOSKOWITZ DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:MOSKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-530-0802
Mailing Address - Street 1:5415 WEST CEDAR LANE
Mailing Address - Street 2:SUITE 105B
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1515
Mailing Address - Country:US
Mailing Address - Phone:301-530-0802
Mailing Address - Fax:301-530-1787
Practice Address - Street 1:5415 WEST CEDAR LANE
Practice Address - Street 2:SUITE 105B
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1515
Practice Address - Country:US
Practice Address - Phone:301-530-0802
Practice Address - Fax:301-530-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01304225100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM497MNOtherBLUE CROSS BLUE SHIELD
T30910Medicare UPIN
128215Medicare PIN