1497887905 NPI number — GEOFFREY E. MOORE, M.D., P.C.

Table of content: (NPI 1497887905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497887905 NPI number — GEOFFREY E. MOORE, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEOFFREY E. MOORE, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1497887905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 TAUGHANNOCK BLVD
Provider Second Line Business Mailing Address:
SUITE 5B
Provider Business Mailing Address City Name:
ITHACA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14850-3231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-257-5990
Provider Business Mailing Address Fax Number:
607-257-5973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 TAUGHANNOCK BLVD
Provider Second Line Business Practice Location Address:
SUITE 5B
Provider Business Practice Location Address City Name:
ITHACA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14850-3231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-257-5990
Provider Business Practice Location Address Fax Number:
607-257-5973
Provider Enumeration Date:
03/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
GEOFFREY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
607-257-5990

Provider Taxonomy Codes

  • Taxonomy code: 207RS0010X , with the licence number:  227508-01 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000927628004 . This is a "HEALTH NOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10077558 . This is a "CDPHP GROUP #J168" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 363245 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000076465 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 227508-9W . This is a "WORKER'S COMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2592101 . This is a "GHI PPO & CMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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