Provider Demographics
NPI:1881762169
Name:MOY, JAMES CW (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CW
Last Name:MOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-1044
Mailing Address - Country:US
Mailing Address - Phone:212-227-1220
Mailing Address - Fax:212-571-1581
Practice Address - Street 1:15 OLIVER ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-1044
Practice Address - Country:US
Practice Address - Phone:212-227-1220
Practice Address - Fax:212-571-1581
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00442851Medicaid
NY342381Medicare ID - Type Unspecified
NY00442851Medicaid