DR. JACOB L MOSKOVIC, M.D. - NPI NUMBER 1205863792

Summary

Provider Name: DR. JACOB L MOSKOVIC, M.D.

NPI Number: 1205863792

Clasification: Psychiatry & Neurology (2084P0802X)

Specialization: Addiction Psychiatry

Organization: JACOB L. MOSKOVIC, M.D. S.C.

Address:
120 W EASTMAN ST
SUITE 202
ARLINGTON HEIGHTS, IL
ZIP 60004

Phone Number: (847) 590-0050



Detailed Information

DR. Jacob L Moskovic, M.D. is an addiction psychiatrist in Arlington Heights, IL with 52 years of experience. The provider is addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. The assigned NPI number for this provider is 1205863792 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business address is:

120 W EASTMAN ST
SUITE 202
ARLINGTON HEIGHTS, IL
ZIP 60004-937
Phone: (847) 590-0050
Fax: (847) 590-0080

The enumeration date for this NPI number is 6/28/2006 and was last updated on 12/6/2010.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 2084P0802X Psychiatry & Neurology Addiction Psychiatry 036-040989 IL No
2 2084P0805X Psychiatry & Neurology Geriatric Psychiatry 036-040989 IL No
3 2084P0800X Psychiatry & Neurology Psychiatry 036-040989 IL Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 C41372 MEDICARE UPIN IL
2 458920 MEDICARE ID-TYPE UNSPECIFIED IL
3 36040989 MEDICAID IL

NPI Record

No. Field Name Field Value
1 NPI 1205863792
2 Entity Type Code 1
3 Provider Last Name Legal Name MOSKOVIC
4 Provider First Name JACOB
5 Provider Middle Name L
6 Provider Name Prefix Text DR.
7 Provider Credential Text M.D.
8 Provider First Line Business Practice Location Address 120 W EASTMAN ST
9 Provider Second Line Business Practice Location Address SUITE 202
10 Provider Business Practice Location Address City Name ARLINGTON HEIGHTS
11 Provider Business Practice Location Address State Name IL
12 Provider Business Practice Location Address Postal Code 600045937
13 Provider Business Practice Location Address Country Code If outside U S US
14 Provider Business Practice Location Address Telephone Number 8475900050
15 Provider Business Practice Location Address Fax Number 8475900080
16 Provider Enumeration Date 6/28/2006
17 Last Update Date 12/6/2010
18 Provider Gender Code M
19 Healthcare Provider Taxonomy Code 1 2084P0802X
20 Provider License Number 1 036-040989
21 Provider License Number State Code 1 IL
22 Healthcare Provider Primary Taxonomy Switch 1 N
23 Healthcare Provider Taxonomy Code 2 2084P0805X
24 Provider License Number 2 036-040989
25 Provider License Number State Code 2 IL
26 Healthcare Provider Primary Taxonomy Switch 2 N
27 Healthcare Provider Taxonomy Code 3 2084P0800X
28 Provider License Number 3 036-040989
29 Provider License Number State Code 3 IL
30 Healthcare Provider Primary Taxonomy Switch 3 Y
31 Other Provider Identifier 1 C41372
32 Other Provider Identifier Type Code 1 02
33 Other Provider Identifier State 1 IL
34 Other Provider Identifier 2 458920
35 Other Provider Identifier Type Code 2 04
36 Other Provider Identifier State 2 IL
37 Other Provider Identifier 3 36040989
38 Other Provider Identifier Type Code 3 05
39 Other Provider Identifier State 3 IL
40 Is Sole Proprietor Y

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This page was last updated on: 7/15/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.