Healthcare Provider Details

I. General information

NPI: 1073809539
Provider Name (Legal Business Name): ANDREA PRIMIANI MOY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 MARCUS AVE STE 300
NEW HYDE PARK NY
11042
US

IV. Provider business mailing address

2821 48TH ST
ASTORIA NY
11103-1239
US

V. Phone/Fax

Practice location:
  • Phone: 516-719-3376
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number289674
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: