Provider Demographics
NPI:1245490374
Name:MOON, CAROLINE M (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:M
Last Name:MOON
Suffix:
Gender:F
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:NEW YORK MEDICAL COLLEGE
Mailing Address - Street 2:MUNGER PAVILION, DEPARTMENT OF PEDIATRICS
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-593-8850
Mailing Address - Fax:914-593-8833
Practice Address - Street 1:NEW YORK MEDICAL COLLEGE
Practice Address - Street 2:MUNGER PAVILION, DEPARTMENT OF PEDIATRICS
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-593-8850
Practice Address - Fax:914-593-8833
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY248907208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02987759Medicaid
NYA400006638Medicare PIN
NYA400006639Medicare PIN