Provider Demographics
NPI:1760727432
Name:MOSKOWITZ, ELISSA S (RN)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:S
Last Name:MOSKOWITZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CRANBERRY DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-2203
Mailing Address - Country:US
Mailing Address - Phone:845-827-5963
Mailing Address - Fax:
Practice Address - Street 1:28 CRANBERRY DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-2203
Practice Address - Country:US
Practice Address - Phone:845-827-5963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY369235-1163W00000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse