Healthcare Provider Details

I. General information

NPI: 1467024687
Provider Name (Legal Business Name): ALISON K MOY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 07/17/2023
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CELEBRATION DR
ROCHESTER NY
14620-2664
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 278797
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-7546
  • Fax:
Mailing address:
  • Phone: 585-275-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number348881
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209023591
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: