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NPI Code Detail

MEDICARE: JASON MOORE

MEDICARE: JASON 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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1134602204
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON MOORE
Provider Business Mailing Address
First Line : 55 DODGE RD
Second Line :
City : GETZVILLE
State : NY
Zip : 14068-1205
Country : US
Telephone Number : 716-831-2700
Fax Number :
Provider Business Practice Location Address
First Line : 2400 PINE AVE
Second Line :
City : NIAGARA FALLS
State : NY
Zip : 14301-2402
Country : US
Telephone Number : 716-505-1060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2018
Last Update Date : 04/20/2026

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Directions to “ JASON MOORE ” Practice Location

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