Provider Demographics
NPI:1609896372
Name:MOONEY, ROBERT ARTHUR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ARTHUR
Last Name:MOONEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ROYALE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8419
Mailing Address - Country:US
Mailing Address - Phone:585-223-0002
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF ROCHESTER MEDICAL CTR
Practice Address - Street 2:BOX 626, 601 ELMWOOD AVE.
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-7811
Practice Address - Fax:585-756-4468
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMOONR1246QC1000X, 246QL0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered246QC1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyChemistry
Not Answered246QL0901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management, Diplomate
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMOONR1OtherNYSDOH C OF Q CODE