Provider Demographics
NPI:1699212183
Name:MOSES, MARIAN D (MS ED)
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:D
Last Name:MOSES
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:MS
Other - First Name:MARIAN
Other - Middle Name:D
Other - Last Name:MOSES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ED
Mailing Address - Street 1:15 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3609
Mailing Address - Country:US
Mailing Address - Phone:516-425-7981
Mailing Address - Fax:
Practice Address - Street 1:15 MAINE AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3609
Practice Address - Country:US
Practice Address - Phone:516-425-7981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist