Healthcare Provider Details

I. General information

NPI: 1508997727
Provider Name (Legal Business Name): MR. NOEL MOYA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 NIAGARA STREET NIAGARA SKILL CENTER
BUFFALO NY
14201
US

IV. Provider business mailing address

430 NIAGARA STREET NIAGARA SKILL CENTER
BUFFALO NY
14201
US

V. Phone/Fax

Practice location:
  • Phone: 716-856-9835
  • Fax: 716-856-5614
Mailing address:
  • Phone: 716-856-9835
  • Fax: 716-856-5614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: