Provider Demographics
NPI:1831635945
Name:MOSKOWITZ, ADINA DEVORA
Entity Type:Individual
Prefix:MRS
First Name:ADINA
Middle Name:DEVORA
Last Name:MOSKOWITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADINA
Other - Middle Name:DEVORA
Other - Last Name:GOLDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:439 WALTON
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552
Mailing Address - Country:US
Mailing Address - Phone:516-280-6503
Mailing Address - Fax:516-481-1696
Practice Address - Street 1:439 WALTON ST
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3052
Practice Address - Country:US
Practice Address - Phone:516-280-6503
Practice Address - Fax:516-481-1696
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY424-676-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$Medicaid