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General NPI Number Information
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NPI Number | 1659440170
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Entity Type | Individual
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Provider Name | CAROLE LYSAGHT MOODHE M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 2 PRO HEALTH PLZ
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1111
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Country | US
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Telephone | 516-506-6885
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Fax | 516-608-6824
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Provider Business Mailing Address
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Address Line | 2 PRO HEALTH PLZ
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1111
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Country | US
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Telephone | 516-506-6885
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Fax | 516-608-6824
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 181854
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 181854
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License Number State | NY
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