Provider Demographics
NPI:1780050500
Name:MOORE, CURTIS ANDREW
Entity type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:ANDREW
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WASHINGTON ST APT 5U
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3115
Mailing Address - Country:US
Mailing Address - Phone:516-204-8896
Mailing Address - Fax:
Practice Address - Street 1:100 WASHINGTON ST APT 5U
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3115
Practice Address - Country:US
Practice Address - Phone:516-204-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-16
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYBN15001971253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY474592083OtherINDIVIUAL PROVIDER