Basic Information
| Provider Information | |||||||||
| NPI: | 1770965436 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAYFIELD | ||||||||
| FirstName: | MOSHE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2025 CRESCENT ST | ||||||||
| Address2: | 2B | ||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111054316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3477241180 | ||||||||
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| Practice Location | |||||||||
| Address1: | 211 E 79TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100750819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128791600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2015 | ||||||||
| LastUpdateDate: | 07/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 695125 | NY | N | Nursing Service Providers | Registered Nurse | 363LA2200X | F309119 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.