Provider Demographics
NPI:1194219980
Name:MOY, MELISSA (APN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MOY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3820
Mailing Address - Country:US
Mailing Address - Phone:917-791-0174
Mailing Address - Fax:
Practice Address - Street 1:378 UNION AVENUE
Practice Address - Street 2:OFC B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-3429
Practice Address - Country:US
Practice Address - Phone:917-791-0174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402384363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health