Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 269744-1 | NY |
NPI | 1083853428 |
---|---|
Provider Name | Dr. Molly Elizabeth Moore |
First Address | Orchard Park, NY 14127-1683 |
Second Address | Orchard Park, NY 14127-1683 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2009 |
Last Update Date | 18/07/2013 |