Provider Demographics
NPI:1114264678
Name:MOJICA, AMY M (MSED, ATC, CSCS)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:MOJICA
Suffix:
Gender:F
Credentials:MSED, ATC, CSCS
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:MERROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED, ATC, CSCS
Mailing Address - Street 1:150 GLENWOOD AVE
Mailing Address - Street 2:M3
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703
Mailing Address - Country:US
Mailing Address - Phone:914-220-2560
Mailing Address - Fax:
Practice Address - Street 1:231 W 246TH ST
Practice Address - Street 2:HORACE MANN SCHOOL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-3430
Practice Address - Country:US
Practice Address - Phone:917-682-2349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001305-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer