Provider Demographics
NPI:1902837198
Name:MOOR, BRUCE B (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:B
Last Name:MOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2270
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12402-2270
Mailing Address - Country:US
Mailing Address - Phone:845-943-5841
Mailing Address - Fax:845-338-5616
Practice Address - Street 1:45 PINE GROVE AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5407
Practice Address - Country:US
Practice Address - Phone:845-943-5841
Practice Address - Fax:845-338-5616
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1236542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00480653Medicaid
NYC08827Medicare UPIN
NY034140Medicare ID - Type UnspecifiedMEDICARE NUMBER