Healthcare Provider Details

I. General information

NPI: 1154018570
Provider Name (Legal Business Name): MICHELA MOSSO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E 70TH ST
NEW YORK NY
10021-9800
US

IV. Provider business mailing address

331 9TH ST APT 2
CARLSTADT NJ
07072-1009
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-2072
  • Fax:
Mailing address:
  • Phone: 518-810-5041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15326400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number354001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: