MEDICARE: ROBERT MOORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	705582	NY

General Provider Information

NPI Number	:	1811731581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT MOORE

Provider Business Mailing Address
First Line	:	5609 205TH ST
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11364-1711
Country	:	US
Telephone Number	:	347-635-0112
Fax Number	:

Provider Business Practice Location Address
First Line	:	5609 205TH ST
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11364-1711
Country	:	US
Telephone Number	:	347-635-0112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2024
Last Update Date	:	06/19/2024

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Directions to “ ROBERT MOORE ” Practice Location

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