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General NPI Number Information
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NPI Number | 1194219980
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Entity Type | Individual
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Provider Name | MELISSA MOY APN
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Gender | Female
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Dates
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Enumeration Date | 06/15/2018
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 378 UNION AVENUE OFC B
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City | BROOKLYN
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State | NY
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Zip | 11211-3429
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Country | US
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Telephone | 917-791-0174
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Fax |
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Provider Business Mailing Address
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Address Line | 49 WINDING WAY
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City | WEST ORANGE
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State | NJ
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Zip | 07052-3820
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Country | US
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Telephone | 917-791-0174
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 402384
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License Number State | NY
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