Healthcare Provider Details

I. General information

NPI: 1467651992
Provider Name (Legal Business Name): MRS. PRISCA HANS MOKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2007
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 GRAND CONCOURSE
BRONX NY
10453-4303
US

IV. Provider business mailing address

3198 GRAND CONCOURSE
BRONX NY
10458-1000
US

V. Phone/Fax

Practice location:
  • Phone: 718-299-7295
  • Fax: 718-299-6797
Mailing address:
  • Phone: 718-618-0401
  • Fax: 718-795-4394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number554211-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF337746
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: