Provider Demographics
NPI:1952077661
Name:MOORE, NIA (MS ED/SPECIAL ED)
Entity Type:Individual
Prefix:
First Name:NIA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS ED/SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 COLLIER AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2616
Mailing Address - Country:US
Mailing Address - Phone:917-238-4599
Mailing Address - Fax:
Practice Address - Street 1:2204 COLLIER AVE APT 2A
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2616
Practice Address - Country:US
Practice Address - Phone:917-238-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-22
Last Update Date:2023-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist