MEDICARE: ABBY ELIZABETH MOTYCKA

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	104100000X	Social Worker	114352	NY

General Provider Information

NPI Number	:	1992528079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBY ELIZABETH MOTYCKA

Provider Business Mailing Address
First Line	:	415 NEWARK ST APT 12G
Second Line	:
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-8430
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 5TH AVE RM 403
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-6643
Country	:	US
Telephone Number	:	212-532-2322
Fax Number	:

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

Provider Enumeration Date	:	11/06/2024
Last Update Date	:	11/06/2024

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