Provider Demographics
NPI:1447443064
Name:MOSHENBERG, HELEN
Entity type:Individual
Prefix:DR
First Name:HELEN
Middle Name:
Last Name:MOSHENBERG
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 1:390 VAN NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4723
Mailing Address - Country:US
Mailing Address - Phone:917-881-7978
Mailing Address - Fax:
Practice Address - Street 1:390 VAN NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4723
Practice Address - Country:US
Practice Address - Phone:917-881-7978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist