Kenneth Allen Moberg, NURSE PRACTITIONER

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

F302611-1 Issued in NY

Practice address

121B West 20TH Street
Village Diagnostic & Treatment Center
New York, NY 10011

Phone

(212) 337-9290

Fax

(212) 337-9275

NPI assigned

Jun 10, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678

Interoperability endpoints

• Direct secure messaging: kenneth.moberg@pri1.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bronx Medical Practice P.C.

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1356726087
  Medicare reassignment NPD
• Essen Medical Associates, PC

  • Legal Medicine
  • Bronx, NY
  • NPI 1366418709
  Medicare reassignment NPD
• Essen Medical Urgicare, PLLC

  • Urgent Care Clinic/Center
  • Bronx, NY
  • NPI 1841607298
  Medicare reassignment NPD
• House Call Medical Services of New York, PLLC

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1851345946
  Medicare reassignment NPD
• Parcare Community Health Network Inc

  • Multi-Specialty Clinic/Center
  • Brooklyn, NY
  • NPI 1730454083
  Medicare reassignment NPD
• Project Renewal Inc

  • Primary Care Clinic/Center
  • New York, NY
  • NPI 1598770018
  Medicare reassignment NPD
• Essen Medical Associates, PC

  • Podiatrist
  • Bronx, NY
  • NPI 1720799158
  NPD
• Essen Medical Associates,PC

  • Legal Medicine (M.D./D.O.) Physician
  • Jamaica, NY
  • NPI 1700023926
  NPD
• Parcare Community Health Network Inc

  • Multi-Specialty Clinic/Center
  • Brooklyn, NY
  • NPI 1942795943
  NPD
• Project Renewal Inc

  • Federally Qualified Health Center (FQHC)
  • Bronx, NY
  • NPI 1821740275
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377561600000",
    "number": "1033379540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121B WEST 20TH STREET",
            "address_2": "VILLAGE DIAGNOSTIC & TREATMENT CENTER",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10011",
            "telephone_number": "212-337-9290",
            "fax_number": "212-337-9275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121B WEST 20TH STREET",
            "address_2": "VILLAGE DIAGNOSTIC & TREATMENT CENTER",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10011",
            "telephone_number": "212-337-9290",
            "fax_number": "212-337-9275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOBERG",
        "first_name": "KENNETH",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-10",
        "last_updated": "2013-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F302611-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03084613",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laleh Moazen, M.D.
• Sara Mobasseri- Egoavil, MD
• Marjon Mobasseri
• Emily Mobbs, DPT
• Kyle Mobbs, MD
• Mobile Cardio Vascular Inc.,
• Mobile Health Medical Services PC
• Mobile Health Medical Services PC
• Mobile Medical Care PC
• Mobile Medical Eye Care, P.C.

• Adult Health Nurse Practitioner in New York, NY
• Providers in New York, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.