Individual provider Active NPI

Agnes Moczydlowska, CRNA

  • Certified Registered Nurse Anesthetist
  • New York, NY
National Provider Identifier
1689806168
Registry record updated Aug 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
511715 Issued in NY
Practice address
560 1St Ave
Rusk 607
New York, NY 10016-6402
Phone
(212) 263-5072
NPI assigned
Aug 17, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 511715 NY Primary

Addresses

Primary practice location

560 1St Ave
Rusk 607
New York, NY 10016-6402

Mailing address

560 1St Ave
Rusk 607
New York, NY 10016-6402
Phone (212) 263-5072

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090930000002 NY Practitioner - Certified Registered Nurse Anesthetist (Crna) 7517003825 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
511715NYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
5000 Avenue K Medical Assocs PC CurrentSince Sep 23, 2022 Accepting new patients

Locations

5000 Avenue K
Brooklyn, NY 11234
Phone (718) 629-5590

1901 Utica Ave
Brooklyn, NY 11234
Phone (718) 520-0857

1901 Utica Ave
#K
Brooklyn, NY 11234

128 Mott St
Ste 202
New York, NY 10013
Phone (347) 417-9089

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1250467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250467200000",
    "number": "1689806168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 1ST AVE",
            "address_2": "RUSK 607",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100166402",
            "telephone_number": "212-263-5072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 1ST AVE",
            "address_2": "RUSK 607",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100166402",
            "telephone_number": "212-263-5072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOCZYDLOWSKA",
        "first_name": "AGNES",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-17",
        "last_updated": "2009-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "511715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.