Individual
MANUEL MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
90 ELLWOOD ST, APT 3D, NEW YORK, NY 10040-2032
(347) 244-0002
Mailing address
90 ELLWOOD ST, 3D, NEW YORK, NY 10040-2032
(347) 244-0002
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
252Y00000X
—
NY
Enumeration date
07/20/2015
Last updated
07/20/2015
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