Basic Information
| Provider Information | |||||||||
| NPI: | 1790751402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOSBERG | ||||||||
| FirstName: | HERBERT | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27842 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100877842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186701651 | ||||||||
| FaxNumber: | 7187401551 | ||||||||
| Practice Location | |||||||||
| Address1: | 18904 HILLSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | HOLLIS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114231938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187405545 | ||||||||
| FaxNumber: | 7187401551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 09/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 109340 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00241901 | 05 | NY | MEDICAID |