=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760685887
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDY LEE MOY D.M.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2007
-----------------------------------------------------
Last Update Date | 10/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 10TH AVE ST. LUKE'S ROOSEVELT HOSPITAL CENTER, SUITE 2T
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-1147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-523-6500
-----------------------------------------------------
Fax | 212-523-7182
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 95000-2240
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19195-2240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-523-6500
-----------------------------------------------------
Fax | 212-523-7182
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 053180
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------