Organization
CHARLES E MOISAN JR MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANNE C AHRENT (OFFICE MANAGER)
(518) 562-3204
Entity
Organization
Contact information
Practice address
80 PARK ST, ELIZABETHTOWN, NY 12932-2304
(518) 873-6340
Mailing address
80 PARK ST, ELIZABETHTOWN, NY 12932-2304
(518) 873-6340
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
102273
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00636686
—
NY
Enumeration date
05/28/2010
Last updated
06/01/2010
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