Healthcare Provider Details

I. General information

NPI: 1295469120
Provider Name (Legal Business Name): MOXIE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 03/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6011 39TH AVE #1
WOODSIDE NY
11377
US

IV. Provider business mailing address

6319 ROOSEVELT AVE # 211
WOODSIDE NY
11377-3641
US

V. Phone/Fax

Practice location:
  • Phone: 646-504-8944
  • Fax:
Mailing address:
  • Phone: 646-504-8894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. NATALIE S HOWARD
Title or Position: FNP-C
Credential:
Phone: 646-504-8894