Healthcare Provider Details

I. General information

NPI: 1295156628
Provider Name (Legal Business Name): MOSES NGIGI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOSES NGIGI RN

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 WALTHAM ST
LEXINGTON MA
02421-8033
US

IV. Provider business mailing address

1040 WALTHAM ST
LEXINGTON MA
02421-8033
US

V. Phone/Fax

Practice location:
  • Phone: 781-761-5121
  • Fax: 781-860-0589
Mailing address:
  • Phone: 781-761-5121
  • Fax: 781-860-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN284885
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: