Individual
DR. GAVAN DAVID MOYNIHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
332 E MAIN ST, BAY SHORE, NY 11706-8404
(631) 666-0500
(631) 666-0503
Mailing address
332 E MAIN ST, BAY SHORE, NY 11706-8404
(631) 666-0500
(631) 666-0503
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
122511
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00627990
—
NY
Enumeration date
03/24/2006
Last updated
09/16/2008
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