Healthcare Provider Details

I. General information

NPI: 1609976331
Provider Name (Legal Business Name): GEOFFREY E. MOORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 BURRSTONE RD
NEW HARTFORD NY
13413-1001
US

IV. Provider business mailing address

1729 BURRSTONE RD
NEW HARTFORD NY
13413-1001
US

V. Phone/Fax

Practice location:
  • Phone: 315-624-1914
  • Fax: 315-624-1917
Mailing address:
  • Phone: 315-624-1914
  • Fax: 315-624-1917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number227508-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: