Healthcare Provider Details

I. General information

NPI: 1548072721
Provider Name (Legal Business Name): JOHN MOYER REGISTED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SOUTH AVE # 11530
GARDEN CITY NY
11530-4299
US

IV. Provider business mailing address

1 SOUTH AVE # 11530
GARDEN CITY NY
11530-4299
US

V. Phone/Fax

Practice location:
  • Phone: 917-268-1189
  • Fax:
Mailing address:
  • Phone: 917-268-1189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number845333
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR24761000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF407741-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: