Provider Demographics
NPI:1093027245
Name:MOYO, MZINGAYE LEEROY GUGULETHU (MD)
Entity Type:Individual
Prefix:DR
First Name:MZINGAYE
Middle Name:LEEROY GUGULETHU
Last Name:MOYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUSTAVE L LEVY PL # 1118
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:FIRST AVENUE AT 16TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-0000
Practice Address - Country:US
Practice Address - Phone:212-844-1808
Practice Address - Fax:212-420-2025
Is Sole Proprietor?:No
Enumeration Date:2010-07-04
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA40706208M00000X
FLTRN14935390200000X
NY301461208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program