Individual
EDWARD ERVIN MOAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
1 WEST AVE STE 230, SARATOGA SPRINGS, NY 12866-6050
(518) 583-5300
Mailing address
1 GLENHAVEN SQ, TROY, NY 12180-8600
(518) 326-5653
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
CT
Other
Enumeration date
03/21/2007
Last updated
07/26/2007
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