Provider Demographics
NPI:1750507737
Name:MOSES, NELSON (PHD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:
Last Name:MOSES
Suffix:
Gender:M
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1130
Mailing Address - Country:US
Mailing Address - Phone:516-431-3211
Mailing Address - Fax:516-431-4211
Practice Address - Street 1:118 OHIO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1130
Practice Address - Country:US
Practice Address - Phone:516-431-3211
Practice Address - Fax:516-431-4211
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001515235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist