Provider Demographics
NPI:1386279867
Name:MORITZ, ESTHER (EMT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:MORITZ
Suffix:
Gender:F
Credentials:EMT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SPRING ST # A
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-2221
Mailing Address - Country:US
Mailing Address - Phone:412-499-0451
Mailing Address - Fax:
Practice Address - Street 1:279 TIMBERWOLF DR
Practice Address - Street 2:
Practice Address - City:LEHMAN TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18324
Practice Address - Country:US
Practice Address - Phone:412-499-0451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146N00000X, 390200000X
PART0078252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer