Provider Demographics
NPI:1194766709
Name:MOSCICKI, HENRY E (FNP)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:E
Last Name:MOSCICKI
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CITY CENTER
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020
Mailing Address - Country:US
Mailing Address - Phone:585-344-4444
Mailing Address - Fax:585-219-6114
Practice Address - Street 1:35 BATAVIA CITY CTR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2107
Practice Address - Country:US
Practice Address - Phone:585-344-4444
Practice Address - Fax:585-219-6114
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01973239Medicaid
NY01973239Medicaid
NYAA0556Medicare PIN
NYCC1199Medicare ID - Type Unspecified