Provider Demographics
NPI:1528549128
Name:MOQUETE, JANYLL (MD)
Entity Type:Individual
Prefix:
First Name:JANYLL
Middle Name:
Last Name:MOQUETE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 AUDUBON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6301
Mailing Address - Country:US
Mailing Address - Phone:212-568-6972
Mailing Address - Fax:212-568-2821
Practice Address - Street 1:248 AUDUBON AVE APT 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6301
Practice Address - Country:US
Practice Address - Phone:212-568-6972
Practice Address - Fax:212-568-2821
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY313725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program