Provider Demographics
NPI:1780981910
Name:THOMAS O. MULDOON, M.D, P.C.
Entity type:Organization
Organization Name:THOMAS O. MULDOON, M.D, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:MULDOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-979-4595
Mailing Address - Street 1:310 EAST 14 STREET
Mailing Address - Street 2:SUITE 402
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4201
Mailing Address - Country:US
Mailing Address - Phone:212-979-4595
Mailing Address - Fax:212-979-4591
Practice Address - Street 1:310 EAST 14 STREET
Practice Address - Street 2:SUITE 402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4201
Practice Address - Country:US
Practice Address - Phone:212-979-4595
Practice Address - Fax:212-979-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY91604207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B15701Medicare UPIN
509661Medicare Oscar/Certification