Provider Demographics
NPI:1689886020
Name:MOSER, JOHN A (AT,C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:MOSER
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 WATERVLIET SHAKER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-2011
Mailing Address - Country:US
Mailing Address - Phone:518-376-7126
Mailing Address - Fax:518-869-9987
Practice Address - Street 1:1070 WATERVLIET SHAKER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-2011
Practice Address - Country:US
Practice Address - Phone:518-376-7126
Practice Address - Fax:518-869-9987
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000783-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer