Provider Demographics
NPI:1457422255
Name:MOSS, SCOTT A (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:MOSS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SNOOP ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-3431
Mailing Address - Country:US
Mailing Address - Phone:845-782-0772
Mailing Address - Fax:845-782-2111
Practice Address - Street 1:3 SNOOP ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-3431
Practice Address - Country:US
Practice Address - Phone:845-782-0772
Practice Address - Fax:845-782-2111
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005702111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX43231Medicare ID - Type UnspecifiedPROVIDER ID