Provider Demographics
NPI:1356461537
Name:MOY, ANNETTE (LAC)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:
Last Name:MOY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 BEVERLY ROAD
Mailing Address - Street 2:4H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3135
Mailing Address - Country:US
Mailing Address - Phone:917-865-3273
Mailing Address - Fax:
Practice Address - Street 1:11 W 32ND ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3819
Practice Address - Country:US
Practice Address - Phone:917-865-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001349-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist