Basic Information
| Provider Information | |||||||||
| NPI: | 1033531173 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOSIER | ||||||||
| FirstName: | VIRGINIA | ||||||||
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| Credential: | CNIM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 W RAMBO ST | ||||||||
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| City: | BRIDGEPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194051126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106136068 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1086 TEANECK RD | ||||||||
| Address2: | SUITE 4A | ||||||||
| City: | TEANECK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076664854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018629900 | ||||||||
| FaxNumber: | 2018629136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2014 | ||||||||
| LastUpdateDate: | 01/08/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | 1526 | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.