Provider Demographics
NPI:1235748658
Name:MOY, MEAGAN E
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:E
Last Name:MOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8624 SALT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9760
Mailing Address - Country:US
Mailing Address - Phone:845-518-1329
Mailing Address - Fax:
Practice Address - Street 1:8624 SALT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9760
Practice Address - Country:US
Practice Address - Phone:845-518-1329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator