Individual
MR. KENNETH ALLEN MOBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
121B WEST 20TH STREET, VILLAGE DIAGNOSTIC & TREATMENT CENTER, NEW YORK, NY 10011
(212) 337-9290
(212) 337-9275
Mailing address
121B WEST 20TH STREET, VILLAGE DIAGNOSTIC & TREATMENT CENTER, NEW YORK, NY 10011
(212) 337-9290
(212) 337-9275
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F302611-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03084613
—
NY
Enumeration date
06/10/2008
Last updated
08/27/2013
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