1972723013 NPI number — DR. DAVID PAUL GUREASKO MOORE PHD

Table of content: DR. DAVID PAUL GUREASKO MOORE PHD (NPI 1972723013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972723013 NPI number — DR. DAVID PAUL GUREASKO MOORE PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUREASKO MOORE
Provider First Name:
DAVID
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1972723013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2505 CARMEL AVE SUITE 210
Provider Second Line Business Mailing Address:
SLS RESIDENTIAL INC
Provider Business Mailing Address City Name:
BREWSTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-721-7262
Provider Business Mailing Address Fax Number:
845-279-7678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2505 CARMEL AVE SUITE 210
Provider Second Line Business Practice Location Address:
SLS RESIDENTIAL INC
Provider Business Practice Location Address City Name:
BREWSTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-721-7262
Provider Business Practice Location Address Fax Number:
845-279-7678
Provider Enumeration Date:
04/30/2007

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:  015968 , 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)





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