Basic Information
| Provider Information | |||||||||
| NPI: | 1063404093 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOSKOFF | ||||||||
| FirstName: | LANE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 670 LAWN AVE | ||||||||
| Address2: | SU 4 | ||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189601571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152570414 | ||||||||
| FaxNumber: | 2152571740 | ||||||||
| Practice Location | |||||||||
| Address1: | 670 LAWN AVE | ||||||||
| Address2: | SU 4 | ||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189601571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152570414 | ||||||||
| FaxNumber: | 2152571740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | MD061728L | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0017042630003 | 05 | PA | MEDICAID | 100769 | 01 | OTHER BS | OTHER | 0743293000 | 01 | INDEPENDENCE BLUE CROSS | OTHER | 30022260 | 01 | OTHER HMO | OTHER | 5043628 | 01 | AETNA | OTHER |