Provider Demographics
NPI:1295156628
Name:NGIGI, MOSES
Entity type:Individual
Prefix:
First Name:MOSES
Middle Name:
Last Name:NGIGI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MOSES
Other - Middle Name:
Other - Last Name:NGIGI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1040 WALTHAM ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8033
Mailing Address - Country:US
Mailing Address - Phone:781-761-5121
Mailing Address - Fax:781-860-0589
Practice Address - Street 1:1040 WALTHAM ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-8033
Practice Address - Country:US
Practice Address - Phone:781-761-5121
Practice Address - Fax:781-860-0589
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN284885163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18633OtherBCBS
MA042611055OtherTAX ID
MA1004745OtherNHP
MA1303287OtherMBHP
MA0000023532OtherBMC
MA1303287Medicaid
MA99618201OtherNETWORK HEALTH
MA1303287OtherMBHP