Ethan Moskovic, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

060576 Issued in NY

Practice address

324 Elmira Rd Ste 200
Ithaca, NY 14850-5106

Phone

(607) 273-3000

NPI assigned

May 30, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576022400000",
    "number": "1720570377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73 MURIEL AVE",
            "city": "LAWRENCE",
            "state": "NY",
            "postal_code": "115591810",
            "telephone_number": "516-660-6367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 ELMIRA RD STE 200",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148505106",
            "telephone_number": "607-273-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSKOVIC",
        "first_name": "ETHAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-30",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "060576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Anne Beyea Morse
• Laura Elizabeth Morse, D.C.
• Rebecca L. Mosher, LCSW-R
• John David Mosier
• Sarah Elizabeth Moskey, DC
• Jack P Moss, RN
• Mariah Courtney Mottley
• Kartik Ashwani Moza, M.D.
• Diane Lynn Mueller, LMHC
• Susan Diane Mueller, RN CDE

• Dentist in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.