Healthcare Provider Details

I. General information

NPI: 1245523455
Provider Name (Legal Business Name): SUSAN S MOZES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 05/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OCEAN PKWY
BROOKLYN NY
11235-7745
US

IV. Provider business mailing address

1635 E 21ST ST
BROOKLYN NY
11210-5037
US

V. Phone/Fax

Practice location:
  • Phone: 718-616-3440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number008092
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: