Healthcare Provider Details

I. General information

NPI: 1215048475
Provider Name (Legal Business Name): RACHEL MOYAL RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E 126TH ST 4TH FLOOR
NEW YORK NY
10035-1623
US

IV. Provider business mailing address

126 E 126TH ST 4TH FLOOR
NEW YORK NY
10035-1623
US

V. Phone/Fax

Practice location:
  • Phone: 212-876-5047
  • Fax:
Mailing address:
  • Phone: 212-876-5047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number010162
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: