Provider Demographics
NPI:1083944508
Name:MOORE, DENISE (LPN)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
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 1:263 E 42ND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-4019
Mailing Address - Country:US
Mailing Address - Phone:347-232-4729
Mailing Address - Fax:718-856-8686
Practice Address - Street 1:344 W 36TH ST
Practice Address - Street 2:SUITE 404
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7598
Practice Address - Country:US
Practice Address - Phone:212-560-6757
Practice Address - Fax:212-244-2034
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084987-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse