Healthcare Provider Details

I. General information

NPI: 1164623708
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER MOY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8710 QUEENS BLVD FL 1
ELMHURST NY
11373-4419
US

IV. Provider business mailing address

8710 QUEENS BLVD FL 1
ELMHURST NY
11373-4419
US

V. Phone/Fax

Practice location:
  • Phone: 917-396-4343
  • Fax:
Mailing address:
  • Phone: 917-396-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number193909
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: