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General NPI Number Information
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NPI Number | 1598835175
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Entity Type | Individual
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Provider Name | PETER ANDRE MOISAN PHD
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Gender | Male
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3055 ROUTE 9
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City | VALATIE
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State | NY
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Zip | 12184-0570
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Country | US
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Telephone | 518-758-2237
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Fax | 518-732-1137
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Provider Business Mailing Address
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Address Line | PO BOX 570
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City | VALATIE
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State | NY
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Zip | 12184
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Country | US
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Telephone | 518-758-2237
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Fax | 518-732-1137
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 013576
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 7347
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY15331
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License Number State | CA
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