Healthcare Provider Details

I. General information

NPI: 1447785225
Provider Name (Legal Business Name): ABRAM MOSHEYEV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 03/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 PENNSYLVANIA AVE
BROOKLYN NY
11239-2103
US

IV. Provider business mailing address

6923 171ST ST
FRESH MEADOWS NY
11365-3314
US

V. Phone/Fax

Practice location:
  • Phone: 718-642-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number059748
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: