Provider Demographics
NPI:1801314877
Name:HILL-MOSQUIN, AMANDA MARIE (PA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:HILL-MOSQUIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:49 KENNETH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4928
Mailing Address - Country:US
Mailing Address - Phone:631-793-0279
Mailing Address - Fax:
Practice Address - Street 1:1111 FRANKLIN AVE FL 1
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1617
Practice Address - Country:US
Practice Address - Phone:516-741-4138
Practice Address - Fax:516-294-4301
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021046-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant