Healthcare Provider Details

I. General information

NPI: 1881762169
Provider Name (Legal Business Name): JAMES C.W. MOY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OLIVER ST
NEW YORK NY
10038-1044
US

IV. Provider business mailing address

15 OLIVER ST
NEW YORK NY
10038-1044
US

V. Phone/Fax

Practice location:
  • Phone: 212-227-1220
  • Fax: 212-571-1581
Mailing address:
  • Phone: 212-227-1220
  • Fax: 212-571-1581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number129875
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: