Healthcare Provider Details

I. General information

NPI: 1306445796
Provider Name (Legal Business Name): ALEXANDRA MOY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2020
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6740 4TH AVE
BROOKLYN NY
11220-5350
US

IV. Provider business mailing address

6740 4TH AVE
BROOKLYN NY
11220-5350
US

V. Phone/Fax

Practice location:
  • Phone: 929-455-2700
  • Fax:
Mailing address:
  • Phone: 929-455-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346577
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: