Healthcare Provider Details

I. General information

NPI: 1609896372
Provider Name (Legal Business Name): ROBERT ARTHUR MOONEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF ROCHESTER MEDICAL CTR BOX 626, 601 ELMWOOD AVE.
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

14 ROYALE DR
FAIRPORT NY
14450-8419
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-7811
  • Fax: 585-756-4468
Mailing address:
  • Phone: 585-223-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QC1000X
TaxonomyChemistry Pathology Specialist/Technologist
License NumberMOONR1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code246QL0901X
TaxonomyDiplomate Laboratory Management Specialist/Technologist
License NumberMOONR1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: