Provider Demographics
NPI:1740725282
Name:MOSES, AVA YVETTE
Entity type:Individual
Prefix:MS
First Name:AVA
Middle Name:YVETTE
Last Name:MOSES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W TREMONT AVE
Mailing Address - Street 2:ROOM #267
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-5400
Mailing Address - Country:US
Mailing Address - Phone:718-716-5796
Mailing Address - Fax:718-299-0727
Practice Address - Street 1:40 W TREMONT AVE
Practice Address - Street 2:ROOM #267
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-5400
Practice Address - Country:US
Practice Address - Phone:718-716-5796
Practice Address - Fax:718-299-0727
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14107905235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist