Individual
MRS. AMY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8 43RD ST, CENTEREACH, NY 11720-2325
(631) 285-8000
Mailing address
59 HOOPER ST, PORT JEFFERSON STATION, NY 11776-3803
(631) 476-0407
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
58 014614
NY
Other
Enumeration date
12/20/2013
Last updated
12/20/2013
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