Provider Demographics
NPI:1316001142
Name:MOEZINIA, PATRICIA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:MOEZINIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35A WALKER ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3513
Mailing Address - Country:US
Mailing Address - Phone:212-274-8338
Mailing Address - Fax:212-334-3902
Practice Address - Street 1:35A WALKER ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3513
Practice Address - Country:US
Practice Address - Phone:212-274-8338
Practice Address - Fax:212-334-3902
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041708-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1223G0001XOtherGENERAL PRACTICE