Basic Information
| Provider Information | |||||||||
| NPI: | 1912047309 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOSKOWITZ | ||||||||
| FirstName: | TAMAR | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, CCC SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LICHTENSTEIN | ||||||||
| OtherFirstName: | TAMAR | ||||||||
| OtherMiddleName: | F | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MS, CCC-SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 302 LONGACRE AVE | ||||||||
| Address2: | APT. #B-4 | ||||||||
| City: | WOODMERE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115982551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3477560649 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 921 E NEW YORK AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112031309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187788587 | ||||||||
| FaxNumber: | 7187358938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 06/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 014328-1 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | A400015181 | 01 | MEDICARE PTAN | OTHER |