Individual
JOHNATHAN M MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
55 GREEN HOLLOW RD, DANIELSON, CT 06239-3533
(860) 779-1865
Mailing address
325 N JAMES ST APT 2, PEEKSKILL, NY 10566-2486
(401) 300-7652
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
12/21/2021
Last updated
08/23/2022
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