Provider Demographics
NPI:1912290644
Name:MOOR, ELIAS JEREMIAH (AUD)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:JEREMIAH
Last Name:MOOR
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1996 ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:LAKE KATRINE
Mailing Address - State:NY
Mailing Address - Zip Code:12449-5423
Mailing Address - Country:US
Mailing Address - Phone:845-336-0108
Mailing Address - Fax:845-336-0261
Practice Address - Street 1:1996 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5423
Practice Address - Country:US
Practice Address - Phone:845-336-0108
Practice Address - Fax:845-336-0261
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002709237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter