Provider Demographics
NPI:1902124043
Name:JOHN MOSCATO MD PC
Entity Type:Organization
Organization Name:JOHN MOSCATO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSCATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-662-1221
Mailing Address - Street 1:3552 SOUTHWESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1707
Mailing Address - Country:US
Mailing Address - Phone:716-662-1221
Mailing Address - Fax:
Practice Address - Street 1:3552 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1707
Practice Address - Country:US
Practice Address - Phone:716-662-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124571207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00656015Medicaid
NY00656015Medicaid