Individual
IDEL I MOISA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3 SCHOOL ST, STE 304, GLEN COVE, NY 11542-2548
(516) 671-0085
(516) 671-0272
Mailing address
3 SCHOOL ST, STE 304, GLEN COVE, NY 11542-2548
(516) 671-0085
(516) 671-0272
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
161323-1
NY
207YP0228X
Pediatric Otolaryngology Physician
161323-1
NY
207YX0602X
Otolaryngic Allergy Physician
161323-1
NY
Other
Enumeration date
08/09/2005
Last updated
03/03/2008
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