Basic Information
| Provider Information | |||||||||
| NPI: | 1679652036 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOSKOWITZ | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | LAWRENCE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 134 HOMER AVE | ||||||||
| Address2: | |||||||||
| City: | CORTLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130451206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077588019 | ||||||||
| FaxNumber: | 6077588210 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 ALVENA AVE STE 105 | ||||||||
| Address2: | |||||||||
| City: | CORTLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130451100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077569470 | ||||||||
| FaxNumber: | 6077567048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 207RG0100X | 211608 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 7956439 | 01 | AETNA | OTHER | 2586471 | 01 | UNITEDHEALTHCARE | OTHER | 00246075 | 05 | NY | MEDICAID |