1477815330 NPI number — MRS. AMBREEN MOGHNI SERVICE COORDINATOR

Table of content: MRS. AMBREEN MOGHNI SERVICE COORDINATOR (NPI 1477815330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477815330 NPI number — MRS. AMBREEN MOGHNI SERVICE COORDINATOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOGHNI
Provider First Name:
AMBREEN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SERVICE COORDINATOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477815330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 ROOSEVELT AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
SYOSSET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11791-3064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-496-4460
Provider Business Mailing Address Fax Number:
516-921-4432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 ROOSEVELT AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
SYOSSET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11791-3064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-496-4460
Provider Business Practice Location Address Fax Number:
516-921-4432
Provider Enumeration Date:
06/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  16285 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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