Healthcare Provider Details

I. General information

NPI: 1770956757
Provider Name (Legal Business Name): JONATHAN MOY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 HOPE ST APT 6D
BROOKLYN NY
11211-3455
US

IV. Provider business mailing address

156 HOPE ST APT 6D
BROOKLYN NY
11211-3455
US

V. Phone/Fax

Practice location:
  • Phone: 917-833-8236
  • Fax:
Mailing address:
  • Phone: 917-833-8236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number058060-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: