Healthcare Provider Details

I. General information

NPI: 1386680783
Provider Name (Legal Business Name): JUDITH CLAIR MOORE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3889 NORTH RD
GENESEO NY
14454
US

IV. Provider business mailing address

3889 NORTH RD
GENESEO NY
14454
US

V. Phone/Fax

Practice location:
  • Phone: 585-243-4000
  • Fax: 585-243-4002
Mailing address:
  • Phone: 585-243-4000
  • Fax: 585-243-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF3807831
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: