Individual
THOMAS A MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2432 GRAND CONCOURSE, POE CLINIC, BRONX, NY 10458
(718) 579-7337
(718) 817-7904
Mailing address
2222 28TH ST, ASTORIA, NY 11105-2702
(718) 721-2780
Taxonomy
Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
168593
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01232099
—
NY
Enumeration date
10/31/2006
Last updated
03/30/2010
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