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Organization
TIMOTHY W. MOON,DO, PLLC
Active
Organization
TIMOTHY W. MOON,DO, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY W. MOON D.O. (PRESIDENT)
(315) 486-2987
Entity
Organization
Contact information
Practice address
77 W BARNEY ST, GOUVERNEUR, NY 13642-1040
(315) 287-3285
(315) 287-3280
Mailing address
77 W BARNEY ST, GOUVERNEUR, NY 13642-1040
(315) 287-3285
(315) 287-3280
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
224227
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02501733
—
NY
Enumeration date
04/27/2007
Last updated
11/10/2011
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