NPIMap

Individual provider Active NPI

Nikenston Moise, PA

  • Internal Medicine Physician
  • Port Orange, FL
National Provider Identifier
1205498250
Registry record updated Jun 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
000234-PA Issued in PR
Practice address
3890 Turtle Creek Dr Ste C
Port Orange, FL 32127-9352
Phone
(386) 756-4400
NPI assigned
Jun 30, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 000234-PA PR Primary

Addresses

Primary practice location

3890 Turtle Creek Dr Ste C
Port Orange, FL 32127-9352

Mailing address

3890 Turtle Creek Dr Ste C
Port Orange, FL 32127-9352
Phone (386) 756-4400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
000234-PAPRMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Moise Integrated Service Inc Current Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1561852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561852800000",
    "number": "1205498250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3890 TURTLE CREEK DR STE C",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321279352",
            "telephone_number": "386-756-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3890 TURTLE CREEK DR STE C",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321279352",
            "telephone_number": "386-756-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOISE",
        "first_name": "NIKENSTON",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-30",
        "last_updated": "2019-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PR",
            "license": "000234-PA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.