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General NPI Number Information
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NPI Number | 1174088603
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Entity Type | Individual
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Provider Name | REBECCA MOERS PA
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Gender | Female
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Dates
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Enumeration Date | 02/08/2019
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 4410 SUNRISE HWY
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City | MASSAPEQUA
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State | NY
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Zip | 11758-5346
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Country | US
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Telephone | 516-998-1024
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Fax |
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Provider Business Mailing Address
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Address Line | 348 BEACH 149TH ST
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-1027
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Country | US
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Telephone | 917-704-0978
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 023319
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License Number State | NY
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