Healthcare Provider Details

I. General information

NPI: 1386892305
Provider Name (Legal Business Name): ELVINA MOY P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 AMSTERDAM AVE CLARK 7, ROOM 5732
NEW YORK NY
10025-1716
US

IV. Provider business mailing address

1111 AMSTERDAM AVE CALRK 7, ROOM 5732
NEW YORK NY
10025-1716
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-5918
  • Fax: 212-523-2842
Mailing address:
  • Phone: 212-523-5918
  • Fax: 212-523-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number012681
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: