Provider Demographics
NPI:1871260133
Name:MOSEUK, TINA DEANNE (HIS)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:DEANNE
Last Name:MOSEUK
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036-0817
Mailing Address - Country:US
Mailing Address - Phone:315-676-1041
Mailing Address - Fax:315-676-1047
Practice Address - Street 1:662 S MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036-3533
Practice Address - Country:US
Practice Address - Phone:315-676-1041
Practice Address - Fax:315-676-1047
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000065625237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist