Provider Demographics
NPI:1538364468
Name:TODD MOSENTHAL
Entity type:Organization
Organization Name:TODD MOSENTHAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:PISCITELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-448-0048
Mailing Address - Street 1:37 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1392
Mailing Address - Country:US
Mailing Address - Phone:603-448-0048
Mailing Address - Fax:603-448-2424
Practice Address - Street 1:37 SPENCER ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1392
Practice Address - Country:US
Practice Address - Phone:603-448-0048
Practice Address - Fax:603-448-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0878174400000X
NH189-1085A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE1315Medicare PIN
NHPERE6411Medicare PIN