Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 020100 | CT |
NPI | 1003804600 |
---|---|
Provider Name | Dr. Stephen J. Moses |
First Address | Ansonia, CT 06401-2134 |
Second Address | Ansonia, CT 06401-2134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2005 |
Last Update Date | 28/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B37630 | (02) | CT |