Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 270055 | MA |
NPI | 1013336676 |
---|---|
Provider Name | Andrey Moyko |
First Address | Syracuse, NY 13210-1690 |
Second Address | Syracuse, NY 13210-1690 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2014 |
Last Update Date | 26/10/2021 |