Organization
GEOFFREY E. MOORE, M.D., P.C.
Active
Other names
Healthy Living & Exercise Medicine Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEOFFREY E MOORE M.D. (PRESIDENT)
(607) 257-5990
Entity
Organization
Contact information
Practice address
310 TAUGHANNOCK BLVD, SUITE 5B, ITHACA, NY 14850-3231
(607) 257-5990
(607) 257-5973
Mailing address
310 TAUGHANNOCK BLVD, SUITE 5B, ITHACA, NY 14850-3231
(607) 257-5990
(607) 257-5973
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
227508-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000076465
GHI HMO
NY
01
—
000927628004
HEALTH NOW
NY
01
—
10077558
CDPHP GROUP #J168
NY
01
—
227508-9W
WORKER'S COMP
NY
01
—
2592101
GHI PPO & CMP
NY
01
—
363245
MVP
NY
Enumeration date
03/10/2007
Last updated
08/22/2020
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