Provider Demographics
NPI:1134011182
Name:ST MOSES INC.
Entity type:Organization
Organization Name:ST MOSES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-379-6955
Mailing Address - Street 1:2040 FOREST AVE # 20A
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1755
Mailing Address - Country:US
Mailing Address - Phone:646-379-6955
Mailing Address - Fax:
Practice Address - Street 1:2040 FOREST AVE # 20A
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1755
Practice Address - Country:US
Practice Address - Phone:718-663-2828
Practice Address - Fax:718-663-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy