Basic Information
| Provider Information | |||||||||
| NPI: | 1336318989 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEPHEN MOSES, M.D., LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | ANSONIA | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064012134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037359354 | ||||||||
| FaxNumber: | 2037322106 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | ANSONIA | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064012134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037359354 | ||||||||
| FaxNumber: | 2037322106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2008 | ||||||||
| LastUpdateDate: | 02/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | MOSES | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2037359354 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 020100 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.