Provider Demographics
NPI:1568161081
Name:MOISES, RYZEL MAE (PTA)
Entity Type:Individual
Prefix:MS
First Name:RYZEL MAE
Middle Name:
Last Name:MOISES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1824
Mailing Address - Country:US
Mailing Address - Phone:973-517-9977
Mailing Address - Fax:
Practice Address - Street 1:200 RELLA BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:NY
Practice Address - Zip Code:10901-4245
Practice Address - Country:US
Practice Address - Phone:845-203-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013580225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant