Individual
JI SOO MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AG-ACNP
Contact information
Practice address
10201 66TH RD, FOREST HILLS, NY 11375-2029
(718) 830-4000
Mailing address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-1000
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
F432459-01
NY
363LA2100X
Acute Care Nurse Practitioner
RN2324806
MA
Other
Enumeration date
02/28/2021
Last updated
07/13/2023
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