Healthcare Provider Details

I. General information

NPI: 1073171427
Provider Name (Legal Business Name): CATHERINE MOYLE AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHERINE DIFRISCO AGACNP

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 E 34TH ST
NEW YORK NY
10016-4901
US

IV. Provider business mailing address

40 HEDGES AVE
CHATHAM NJ
07928-2547
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-4615
  • Fax:
Mailing address:
  • Phone: 517-967-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number688160
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: