Provider Demographics
NPI:1083845093
Name:MOSCHAK, VANESSA A (MA SLP)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:A
Last Name:MOSCHAK
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:MISS
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:263 RIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-4256
Mailing Address - Country:US
Mailing Address - Phone:607-757-2152
Mailing Address - Fax:607-757-2864
Practice Address - Street 1:263 RIDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-4256
Practice Address - Country:US
Practice Address - Phone:607-757-2152
Practice Address - Fax:607-757-2864
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017933-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist