Provider Demographics
NPI:1194864272
Name:MOSTON, BEN ROBERT (OTR)
Entity Type:Individual
Prefix:MR
First Name:BEN
Middle Name:ROBERT
Last Name:MOSTON
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 GILLETTE AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2515
Mailing Address - Country:US
Mailing Address - Phone:631-730-5212
Mailing Address - Fax:
Practice Address - Street 1:114 GILLETTE AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2515
Practice Address - Country:US
Practice Address - Phone:631-730-5212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0096411225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist