Healthcare Provider Details

I. General information

NPI: 1205206893
Provider Name (Legal Business Name): RUTH MOZE DNP FNP-BC PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3488 DANIEL CRES
BALDWIN NY
11510-5152
US

IV. Provider business mailing address

3488 DANIEL CRES
BALDWIN NY
11510-5152
US

V. Phone/Fax

Practice location:
  • Phone: 917-742-7408
  • Fax:
Mailing address:
  • Phone: 917-742-7408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF344400
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407618
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN307928
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: