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: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 DRUMLIN CT
NEWARK NY
14513-1863
US

IV. Provider business mailing address

131 DRUMLIN CT
NEWARK NY
14513-1863
US

V. Phone/Fax

Practice location:
  • Phone: 315-332-7400
  • Fax:
Mailing address:
  • Phone: 315-332-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF3807831
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number416572
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: