Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 145492 | NY |
NPI | 1205869583 |
---|---|
Provider Name | J.p. Pleno Moise |
First Address | New York, NY 10025-1556 |
Second Address | New York, NY 10027-7216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 08/07/2007 |