Healthcare Provider Details

I. General information

NPI: 1558560458
Provider Name (Legal Business Name): MARIAN MOCA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE BROOKDALE PLAZA
BROOKLYN NY
11212
US

IV. Provider business mailing address

ONE BROOKDALE PLAZA
BROOKLYN NY
11212
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-6470
  • Fax: 718-240-5451
Mailing address:
  • Phone: 718-240-6470
  • Fax: 718-240-5451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number275172
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: