Provider Demographics
NPI:1942696075
Name:MOSES, AYO (MD)
Entity Type:Individual
Prefix:
First Name:AYO
Middle Name:
Last Name:MOSES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AYOMIDE
Other - Middle Name:
Other - Last Name:BOMIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:127 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-4006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:440 SOUTH RIVERSIDE AVENUE
Practice Address - Street 2:CAREMOUNT MEDICAL PC
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520
Practice Address - Country:US
Practice Address - Phone:914-271-8700
Practice Address - Fax:914-271-9712
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400203058OtherMEDICARE