Provider Demographics
NPI:1841556909
Name:JONATHAN A. MOSELLE,PH.D. P.C
Entity Type:Organization
Organization Name:JONATHAN A. MOSELLE,PH.D. P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOSELLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-643-2999
Mailing Address - Street 1:1244 FT WSHNGTN AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:FT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-1743
Mailing Address - Country:US
Mailing Address - Phone:215-643-2999
Mailing Address - Fax:215-643-4599
Practice Address - Street 1:1244 FT WSHNGTN AVE
Practice Address - Street 2:SUITE K
Practice Address - City:FT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-1743
Practice Address - Country:US
Practice Address - Phone:215-643-2999
Practice Address - Fax:215-643-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003458L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA189672OtherMEDICARE PTAN