Healthcare Provider Details

I. General information

NPI: 1649186065
Provider Name (Legal Business Name): TOVAH J. MORAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 WAVERLY AVE STE 5
PATCHOGUE NY
11772-1597
US

IV. Provider business mailing address

358 BOULDER ST
RONKONKOMA NY
11779-4909
US

V. Phone/Fax

Practice location:
  • Phone: 631-758-5700
  • Fax:
Mailing address:
  • Phone: 516-449-0598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number00701001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: