Provider Demographics
NPI:1841330891
Name:MOSCOU, SUSAN ELIZABETH (FNP, PMHNP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:MOSCOU
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:555 BROADWAY # MH275
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-1186
Mailing Address - Country:US
Mailing Address - Phone:914-674-7866
Mailing Address - Fax:
Practice Address - Street 1:555 BROADWAY
Practice Address - Street 2:MEH 16
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1186
Practice Address - Country:US
Practice Address - Phone:914-674-7866
Practice Address - Fax:914-674-7623
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331167363LF0000X
NY404747363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04351135Medicaid