Provider Demographics
NPI:1609079466
Name:MOCHE, EZRA (DMD)
Entity type:Individual
Prefix:DR
First Name:EZRA
Middle Name:
Last Name:MOCHE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 W 54TH ST
Mailing Address - Street 2:SUITE 1 E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5404
Mailing Address - Country:US
Mailing Address - Phone:212-980-1111
Mailing Address - Fax:
Practice Address - Street 1:45 W 54TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5404
Practice Address - Country:US
Practice Address - Phone:212-980-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0379301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice