Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036.124953 | IL |
Y | 207X00000X | Orthopaedic Surgeon | 049572 | CT |
N | 207XS0117X | Orthopaedic Spine Surgeon | 036.124953 | IL |
N | 207XS0117X | Orthopaedic Spine Surgeon | 049572 | CT |
NPI | 1013222660 |
---|---|
Provider Name | Dr. Isaac Moss |
First Address | Farmington, CT 06030-8082 |
Second Address | Farmington, CT 06030-8082 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2010 |
Last Update Date | 19/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013222660 | (05) | CT |