Healthcare Provider Details

I. General information

NPI: 1073771648
Provider Name (Legal Business Name): WENDY NASH MOYAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WENDY ALICE NASH

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST NYPH MAILBOX 140
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

525 E 68TH ST NYPH MAILBOX 140
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-821-0556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number246310
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: