1255492468 NPI number — MR. DENNIS RAY MOORE M.A., NCSP

Table of content: MR. DENNIS RAY MOORE M.A., NCSP (NPI 1255492468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255492468 NPI number — MR. DENNIS RAY MOORE M.A., NCSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
DENNIS
Provider Middle Name:
RAY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A., NCSP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255492468
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
258 SOUTH STATE STREET
Provider Second Line Business Mailing Address:
R & L OFFICE CENTER
Provider Business Mailing Address City Name:
NEWTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-860-2240
Provider Business Mailing Address Fax Number:
215-860-6778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
258 SOUTH STATE STREET
Provider Second Line Business Practice Location Address:
R & L OFFICE CENTER
Provider Business Practice Location Address City Name:
NEWTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-860-2240
Provider Business Practice Location Address Fax Number:
215-860-6778
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PS004703L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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