MEDICARE: LUCY MOSHKOV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency	2930869	NY

General Provider Information

NPI Number	:	1528608858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCY MOSHKOV

Provider Business Mailing Address
First Line	:	220 FINLEY AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-5649
Country	:	US
Telephone Number	:	718-980-6787
Fax Number	:

Provider Business Practice Location Address
First Line	:	1854 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2119
Country	:	US
Telephone Number	:	917-553-0424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2020
Last Update Date	:	01/15/2020

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Directions to “ LUCY MOSHKOV ” Practice Location

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