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NPI Code Detail

MEDICARE: LANCE RAY MOORE

MEDICARE: LANCE RAY MOORE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1134065881
Entity Type Code : Individual
Provider Name (Legal Business Name) : LANCE RAY MOORE
Provider Business Mailing Address
First Line : 1649 61ST ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11204-2746
Country : US
Telephone Number : 212-481-4040
Fax Number :
Provider Business Practice Location Address
First Line : 1649 61ST ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11204-2746
Country : US
Telephone Number : 212-481-4040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2026
Last Update Date : 04/27/2026

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Directions to “ LANCE RAY MOORE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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