Provider Demographics
NPI:1558650663
Name:MOORE, JILLIAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:G
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10 S POINTE LNDG
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-3481
Mailing Address - Country:US
Mailing Address - Phone:585-426-4084
Mailing Address - Fax:585-426-4631
Practice Address - Street 1:10 S POINTE LNDG
Practice Address - Street 2:SUITE 250
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-3481
Practice Address - Country:US
Practice Address - Phone:585-426-4084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY273594207Q00000X
NY60273594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine