Healthcare Provider Details

I. General information

NPI: 1780784504
Provider Name (Legal Business Name): LINDA JANE MOGGIO M.A., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 PLEASANT AVE
WHITE PLAINS NY
10605-2510
US

IV. Provider business mailing address

44 PLEASANT AVE
WHITE PLAINS NY
10605-2510
US

V. Phone/Fax

Practice location:
  • Phone: 914-949-1965
  • Fax:
Mailing address:
  • Phone: 914-949-1965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number001668
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: