Healthcare Provider Details

I. General information

NPI: 1013003359
Provider Name (Legal Business Name): MOUNTAIN VIEW PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 MARGARET STREET SUITE 100
PLATTSBURGH NY
12901
US

IV. Provider business mailing address

159 MARGARET STREET SUITE 100
PLATTSBURGH NY
12901
US

V. Phone/Fax

Practice location:
  • Phone: 518-324-2040
  • Fax: 518-324-2041
Mailing address:
  • Phone: 518-324-2040
  • Fax: 518-324-2041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2239121
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0031261
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2241781
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2328181
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2242461
License Number StateNY

VIII. Authorized Official

Name: HEIDI JILL MOORE
Title or Position: OWNER MD
Credential: MD
Phone: 518-324-2040