Individual
JANE MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
101 NICOLLS RD, HSC T17-040, STONY BROOK, NY 11794-0001
(631) 873-6663
Mailing address
101 NICOLLS RD # T17-040, STONY BROOK, NY 11794-0001
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
322756
NY
207RP1001X
Pulmonary Disease Physician
Primary
322756
NY
Other
Enumeration date
05/23/2017
Last updated
06/15/2023
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