1235364548 NPI number — MRS. CHRISTINE PATRESE MOSS DPT

Table of content: MRS. CHRISTINE PATRESE MOSS DPT (NPI 1235364548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235364548 NPI number — MRS. CHRISTINE PATRESE MOSS DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSS
Provider First Name:
CHRISTINE
Provider Middle Name:
PATRESE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NASCIMENTO
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
PATRESE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235364548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 LOCUST STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTBURY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-744-3199
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8453 251ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEROSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11426-2114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-744-3199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  027458 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 027458-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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