Provider Demographics
NPI:1538313739
Name:ROBERT V MORIARTY MD PC
Entity Type:Organization
Organization Name:ROBERT V MORIARTY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:V
Authorized Official - Last Name:MORIARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-423-2663
Mailing Address - Street 1:755 NEW YORK AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4240
Mailing Address - Country:US
Mailing Address - Phone:631-423-2663
Mailing Address - Fax:631-423-4715
Practice Address - Street 1:755 NEW YORK AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4240
Practice Address - Country:US
Practice Address - Phone:631-423-2663
Practice Address - Fax:631-423-4715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166856174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDQ7956OtherRAILROAD MEDICARE
NYP00873053OtherRAILROAD MEDICARE - INDIV
NYDQ7956OtherRAILROAD MEDICARE