Provider Demographics
NPI:1659400208
Name:MOULIN, MICHEL F (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHEL
Middle Name:F
Last Name:MOULIN
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 1:210 EAST 47 ST
Mailing Address - Street 2:1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:212-832-0550
Mailing Address - Fax:212-439-7755
Practice Address - Street 1:210 EAST 47TH ST
Practice Address - Street 2:1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-832-0550
Practice Address - Fax:212-439-7755
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134945207W00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00552878Medicaid
NYB14684Medicare UPIN
NY44A481Medicare PIN