Provider Demographics
NPI:1609976331
Name:MOORE, GEOFFREY E (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:E
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 BURRSTONE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-1001
Mailing Address - Country:US
Mailing Address - Phone:315-624-1914
Mailing Address - Fax:315-624-1917
Practice Address - Street 1:1729 BURRSTONE RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1001
Practice Address - Country:US
Practice Address - Phone:315-624-1914
Practice Address - Fax:315-624-1917
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227508-01207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10077558OtherCDPHP
NY363245OtherMVP
NY000000076465OtherGHI HMO
NY000927628002OtherHEALTHNOW
NY2592101OtherGHI PPO & CMP
NYDD6507Medicare ID - Type UnspecifiedINDIVIDUAL
NY000000076465OtherGHI HMO
NY2592101OtherGHI PPO & CMP