Provider Demographics
NPI:1164622494
Name:MOSHERO, GIANNI (PA)
Entity Type:Individual
Prefix:MR
First Name:GIANNI
Middle Name:
Last Name:MOSHERO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 FRANKLIN AVE STE MI-6
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1886
Mailing Address - Country:US
Mailing Address - Phone:516-535-1900
Mailing Address - Fax:
Practice Address - Street 1:1300 FRANKLIN AVE STE MI-6
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1886
Practice Address - Country:US
Practice Address - Phone:516-535-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3643363AS0400X
FLPA9113858363AS0400X
NY011629363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00625155OtherRAILROAD MEDICARE
AZ860087236Medicaid
AZ241913Medicaid
AZZ119821Medicare PIN
AZ860087236Medicaid