Provider Demographics
NPI:1568013415
Name:DAVIS, MORIAH (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:MORIAH
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1236
Mailing Address - Country:US
Mailing Address - Phone:212-722-3636
Mailing Address - Fax:
Practice Address - Street 1:110 E 55TH ST FL 14
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4585
Practice Address - Country:US
Practice Address - Phone:212-283-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant