Provider Demographics
NPI:1053537738
Name:MOSES, BETH H
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:H
Last Name:MOSES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 EAGLES CT
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-9773
Mailing Address - Country:US
Mailing Address - Phone:570-422-1111
Mailing Address - Fax:570-422-1484
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-2816
Practice Address - Country:US
Practice Address - Phone:570-426-7150
Practice Address - Fax:570-426-9484
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN228813-L364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMO71369Medicare UPIN
PAMO71369Medicare ID - Type Unspecified