Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 003146 | NY |
NPI | 1174666846 |
---|---|
Provider Name | Dr. Maureen L Moore |
First Address | Bronx, NY 10465-3849 |
Second Address | Yonkers, NY 10704-3855 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 17/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T52359 | (02) |