Healthcare Provider Details

I. General information

NPI: 1083930689
Provider Name (Legal Business Name): IOANA MOISINI M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E NICOLLET BLVD
BURNSVILLE MN
55337-5714
US

IV. Provider business mailing address

601 ELMWOOD AVENUE URMC BOX 626
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 651-491-9198
  • Fax:
Mailing address:
  • Phone: 585-275-3184
  • Fax: 585-276-2802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number289842
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number67323
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: