Provider Demographics
NPI:1740585991
Name:MOY, AILEEN (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:MOY
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 23RD AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1917
Mailing Address - Country:US
Mailing Address - Phone:614-256-9984
Mailing Address - Fax:
Practice Address - Street 1:12 W 27TH ST FL 9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6903
Practice Address - Country:US
Practice Address - Phone:614-256-9984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004356-1171100000X
NY024261-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist