| NPI | 1487059515 |
|---|---|
| Former Legal Business Name | MOSHOLU MEDICAL GROUP P.C |
| Entity Type | Organization |
| Authorized Contact | THEODORE COSTA DOCU Owner 718-601-0627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 182886) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 245895) |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2020-07-14 |