Individual
DR. BROOKE CAROL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 ROUTE 347, BLDG 14A, STONY BROOK, NY 11790-2554
(631) 689-7800
(631) 689-3016
Mailing address
1500 ROUTE 112 STE 101, PORT JEFFERSON STATION, NY 11776-8054
(631) 751-3000
(631) 509-6559
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
161222
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01130890
—
NY
01
—
0C3233
HEALTHNET
NY
01
—
390001418
MEDICARE RAIL ROAD
NM
01
—
CS629
OXFORD
NY
Enumeration date
06/30/2005
Last updated
09/20/2019
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