Provider Demographics
NPI:1013384015
Name:MOORE, JOY A (LPN)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 W 92ND ST APT 22E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7675
Mailing Address - Country:US
Mailing Address - Phone:347-942-6017
Mailing Address - Fax:
Practice Address - Street 1:74 W 92ND ST APT 22E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7675
Practice Address - Country:US
Practice Address - Phone:347-942-6017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323231164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse