Individual
FREDRIC MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
120 MINEOLA BLVD, SUITE 100, MINEOLA, NY 11501-4073
(516) 663-3010
(516) 663-3026
Mailing address
120 MINEOLA BLVD, SUITE 100, MINEOLA, NY 11501-4073
(516) 663-3010
(516) 663-3026
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
216307
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02382350
—
NY
Enumeration date
08/24/2005
Last updated
02/09/2010
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