Provider Demographics
NPI:1154091718
Name:MOORE, TAYLOR ERIN (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ERIN
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:73 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1233
Mailing Address - Country:US
Mailing Address - Phone:518-514-8304
Mailing Address - Fax:
Practice Address - Street 1:3333 NEW HYDE PARK RD STE 100
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1205
Practice Address - Country:US
Practice Address - Phone:518-514-8304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant