Provider Demographics
NPI:1043574734
Name:MOZES, BETH SANDRA (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:SANDRA
Last Name:MOZES
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 LANETT AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5539
Mailing Address - Country:US
Mailing Address - Phone:718-327-3602
Mailing Address - Fax:
Practice Address - Street 1:816 LANETT AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5539
Practice Address - Country:US
Practice Address - Phone:718-327-3602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1080179252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency