Healthcare Provider Details

I. General information

NPI: 1841362753
Provider Name (Legal Business Name): JOHN MOISES PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 W 32ND ST SUITE 501
NEW YORK NY
10001-3816
US

IV. Provider business mailing address

7A MONTAUK PL
STATEN ISLAND NY
10314-1827
US

V. Phone/Fax

Practice location:
  • Phone: 212-868-0509
  • Fax:
Mailing address:
  • Phone: 718-370-0736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number019626-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: