Provider Demographics
NPI:1154066074
Name:MOISEYENKO, ANDREY (DO)
Entity Type:Individual
Prefix:
First Name:ANDREY
Middle Name:
Last Name:MOISEYENKO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 MEETING HOUSE LANE
Mailing Address - Street 2:STONY BROOK SOUTHAMPTON HOSPITAL INTERN MEDICINE
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:240 MEETING HOUSE LANE
Practice Address - Street 2:STONY BROOK SOUTHAMPTON HOSPITAL INTERN MEDICINE
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968
Practice Address - Country:US
Practice Address - Phone:631-726-0409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program