1114264678 NPI number — MRS. AMY M MOJICA MSED, ATC, CSCS

Table of content: MRS. AMY M MOJICA MSED, ATC, CSCS (NPI 1114264678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114264678 NPI number — MRS. AMY M MOJICA MSED, ATC, CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOJICA
Provider First Name:
AMY
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSED, ATC, CSCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MERROW
Provider Other First Name:
AMY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSED, ATC, CSCS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114264678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 GLENWOOD AVE
Provider Second Line Business Mailing Address:
M3
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-220-2560
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 W 246TH ST
Provider Second Line Business Practice Location Address:
HORACE MANN SCHOOL
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10471-3430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-682-2349
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2013

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: 2255A2300X , with the licence number:  001305-1 , 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)





Copyright © 2007-2025 www.npivalidator.com