Provider Demographics
NPI:1659500502
Name:MOORE, EMILY JAIME (RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:JAIME
Last Name:MOORE
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 FORT WASHINGTON AVENUE
Mailing Address - Street 2:GARDEN LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-305-0983
Mailing Address - Fax:212-305-0178
Practice Address - Street 1:161 FORT WASHINGTON AVE
Practice Address - Street 2:GARDEN LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-0983
Practice Address - Fax:212-305-0178
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY972384133V00000X
NY006661133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered