Healthcare Provider Details

I. General information

NPI: 1275776478
Provider Name (Legal Business Name): DAVID MOYES LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 ROUTE 17M
GOSHEN NY
10924-5241
US

IV. Provider business mailing address

2001 ROUTE 17M
GOSHEN NY
10924-5241
US

V. Phone/Fax

Practice location:
  • Phone: 845-294-6185
  • Fax:
Mailing address:
  • Phone: 845-294-6185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number078887
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: