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General NPI Number Information
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NPI Number | 1417358375
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Entity Type | Individual
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Provider Name | EILEEN MOYNIHAN FNP
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Gender | Female
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 1275 YORK AVE
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City | NEW YORK
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State | NY
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Zip | 10065-6007
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Country | US
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Telephone | 646-996-5946
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Fax |
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Provider Business Mailing Address
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Address Line | 3618 CORLEAR AVE
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City | BRONX
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State | NY
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Zip | 10463-2306
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Country | US
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Telephone | 646-996-5946
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95011169
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 6128
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 339111
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License Number State | NY
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