Provider Demographics
NPI:1295469120
Name:MOXIE WELLNESS
Entity Type:Organization
Organization Name:MOXIE WELLNESS
Other - Org Name:EARTH & HEART PRIMARY CARE PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FNP-C
Authorized Official - Prefix:MS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-504-8894
Mailing Address - Street 1:6319 ROOSEVELT AVE # 211
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3641
Mailing Address - Country:US
Mailing Address - Phone:646-504-8894
Mailing Address - Fax:
Practice Address - Street 1:6011 39TH AVE #1
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377
Practice Address - Country:US
Practice Address - Phone:646-504-8944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-15
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty