Organization Active NPI

Moss Dermatology LLC

  • Dermatology Physician
  • Forest Hills, NY
National Provider Identifier
1780835918
Registry record updated Apr 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
193984 Issued in NY
Legal business name
MOSS DERMATOLOGY LLC
Practice address
10840 Queens Blvd
Forest Hills, NY 11375-5361
Phone
(718) 268-3161
Fax
(718) 268-2311
NPI assigned
Oct 7, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2015

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

Authorized official

Name
Tamara Moss, M.D.NPI 1134143282
Title
Physician
Phone
(718) 268-3161

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 193984 NY Primary

Addresses

Primary practice location

10840 Queens Blvd
Forest Hills, NY 11375-5361

Mailing address

10840 Queens Blvd
Forest Hills, NY 11375-5361
Phone (718) 268-3161

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090526000179 NY Part B Supplier - Clinic/Group Practice 3072662956 Receives reassigned benefits from 3 practitioners
Practice locations: Elmhurst, NY; Forest Hills, NY

National Provider Directory

National Provider Directory

Locations

7410 Broadway
Ste 3
Elmhurst, NY 11373
Phone (718) 971-1340

10840 Queens Blvd
Forest Hills, NY 11375
Phone (718) 268-3161

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429574400000",
    "number": "1780835918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10840 QUEENS BLVD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113755361",
            "telephone_number": "718-268-3161",
            "fax_number": "718-268-2311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10840 QUEENS BLVD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113755361",
            "telephone_number": "718-268-3161",
            "fax_number": "718-268-2311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSS DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-07",
        "last_updated": "2015-04-21",
        "status": "A",
        "authorized_official_last_name": "MOSS",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "718-268-3161",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NY",
            "license": "193984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.