Provider Demographics
NPI:1245318518
Name:MOSENDE-REYES, CRISTANTA (MD)
Entity type:Individual
Prefix:
First Name:CRISTANTA
Middle Name:
Last Name:MOSENDE-REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 MADISON AVE
Mailing Address - Street 2:6TH FLR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2709
Mailing Address - Country:US
Mailing Address - Phone:212-423-4500
Mailing Address - Fax:212-423-1404
Practice Address - Street 1:1879 MADISON AVE
Practice Address - Street 2:6TH FLR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2709
Practice Address - Country:US
Practice Address - Phone:212-423-4500
Practice Address - Fax:212-423-1404
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137605207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355142Medicaid
NY00355142Medicaid
NYB03332Medicare UPIN