Provider Demographics
NPI:1477151561
Name:MEORE, EMMA
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:MEORE
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 1:34 MAPLE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:TUXEDO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:10987-4622
Mailing Address - Country:US
Mailing Address - Phone:845-642-4399
Mailing Address - Fax:
Practice Address - Street 1:34 MAPLE BROOK RD
Practice Address - Street 2:
Practice Address - City:TUXEDO PARK
Practice Address - State:NY
Practice Address - Zip Code:10987-4622
Practice Address - Country:US
Practice Address - Phone:845-642-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program