Provider Demographics
NPI:1205670049
Name:MOSES, ANTHONY S JR
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:S
Last Name:MOSES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 BELLFIELD AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3165
Mailing Address - Country:US
Mailing Address - Phone:678-507-4091
Mailing Address - Fax:
Practice Address - Street 1:5198 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1331
Practice Address - Country:US
Practice Address - Phone:216-378-9101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator