Healthcare Provider Details

I. General information

NPI: 1366367716
Provider Name (Legal Business Name): BRIDGET MOSHER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 3RD ST STE 5
JAMESTOWN NY
14701-5433
US

IV. Provider business mailing address

2 ACADEMY ST RM 201
MAYVILLE NY
14757-1050
US

V. Phone/Fax

Practice location:
  • Phone: 716-661-8330
  • Fax: 716-661-8364
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: