Provider Demographics
NPI:1497887905
Name:GEOFFREY E. MOORE, M.D., P.C.
Entity Type:Organization
Organization Name:GEOFFREY E. MOORE, M.D., P.C.
Other - Org Name:HEALTHY LIVING & EXERCISE MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-257-5990
Mailing Address - Street 1:310 TAUGHANNOCK BLVD
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3231
Mailing Address - Country:US
Mailing Address - Phone:607-257-5990
Mailing Address - Fax:607-257-5973
Practice Address - Street 1:310 TAUGHANNOCK BLVD
Practice Address - Street 2:SUITE 5B
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3231
Practice Address - Country:US
Practice Address - Phone:607-257-5990
Practice Address - Fax:607-257-5973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227508-01207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000927628004OtherHEALTH NOW
NY10077558OtherCDPHP GROUP #J168
NY363245OtherMVP
NY000000076465OtherGHI HMO
NY227508-9WOtherWORKER'S COMP
NY2592101OtherGHI PPO & CMP
NY10077558OtherCDPHP GROUP #J168
NY=========OtherUNITED HEALTHCARE
NY363245OtherMVP