Provider Demographics
NPI:1811188691
Name:MOISES, ABYGAILE MAE (PT)
Entity Type:Individual
Prefix:
First Name:ABYGAILE
Middle Name:MAE
Last Name:MOISES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 CORLEAR AVENUE
Mailing Address - Street 2:11
Mailing Address - City:BRONS
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:646-269-2580
Mailing Address - Fax:
Practice Address - Street 1:2426 EASTCHESTER RD
Practice Address - Street 2:214
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5947
Practice Address - Country:US
Practice Address - Phone:718-653-6400
Practice Address - Fax:718-653-3333
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist