Provider Demographics
NPI:1912638255
Name:MOSLEY, TERRY LAMONT
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LAMONT
Last Name:MOSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 W 139TH ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-7349
Mailing Address - Country:US
Mailing Address - Phone:215-833-0836
Mailing Address - Fax:
Practice Address - Street 1:603 W 139TH ST APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-7349
Practice Address - Country:US
Practice Address - Phone:201-793-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY791869283172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver