Provider Demographics
NPI:1598258634
Name:MOYNIHAN, ALISON ELIZABETH (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:ELIZABETH
Last Name:MOYNIHAN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:ELIZABETH
Other - Last Name:MOYNIHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:601 ELMWOOD AVE BOX 278797
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-7546
Mailing Address - Fax:
Practice Address - Street 1:40 CELEBRATION DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2664
Practice Address - Country:US
Practice Address - Phone:585-275-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316818363AM0700X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical