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General NPI Number Information
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NPI Number | 1508995945
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Entity Type | Individual
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Provider Name | MOSES POWELL L.M.T.
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Gender | Male
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 536 FAIRVIEW AVE
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City | BALDWIN
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State | NY
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Zip | 11510-3705
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Country | US
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Telephone | 516-203-1264
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Fax | 516-867-1162
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Provider Business Mailing Address
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Address Line | 536 FAIRVIEW AVE
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City | BALDWIN
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State | NY
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Zip | 11510-3705
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Country | US
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Telephone | 516-203-1264
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Fax | 516-867-1162
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 010045
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License Number State | NY
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