Provider Demographics
NPI:1871260133
Name:MOSEUK, TINA DEANNE (HIS)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:DEANNE
Last Name:MOSEUK
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9670 BREWERTON RD
Mailing Address - Street 2:
Mailing Address - City:BREWERTON
Mailing Address - State:NY
Mailing Address - Zip Code:13029-8717
Mailing Address - Country:US
Mailing Address - Phone:315-668-1111
Mailing Address - Fax:315-668-1162
Practice Address - Street 1:9670 BREWERTON RD
Practice Address - Street 2:
Practice Address - City:BREWERTON
Practice Address - State:NY
Practice Address - Zip Code:13029-8717
Practice Address - Country:US
Practice Address - Phone:315-668-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000065625237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist