Provider Demographics
NPI:1174516348
Name:MAMOUZETTE, MOISE (MD)
Entity type:Individual
Prefix:DR
First Name:MOISE
Middle Name:
Last Name:MAMOUZETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 678
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00821-0678
Mailing Address - Country:US
Mailing Address - Phone:340-692-6263
Mailing Address - Fax:340-778-4922
Practice Address - Street 1:201-202 ESTATE RUBY
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-692-6263
Practice Address - Fax:340-778-4922
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD 2008-0823207V00000X
VI1566207V00000X
NY225641207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH78333Medicare UPIN