Healthcare Provider Details

I. General information

NPI: 1801967997
Provider Name (Legal Business Name): LIBIA MOY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SCH - PEDIATRIC GASTROENTEROLOGY 269-01 76TH AVENUE
NEW HYDE PARK NY
11040
US

IV. Provider business mailing address

SCH - PEDIATRIC GASTROENTEROLOGY 269-01 76TH AVENUE
NEW HYDE PARK NY
11040
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-3430
  • Fax:
Mailing address:
  • Phone: 718-470-3430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number200320
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: