Individual
THERESA A MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
739 IRVING AVE, SUITE 600, SYRACUSE, NY 13210-1651
(315) 471-0190
(315) 471-0170
Mailing address
1226 E WATER ST, SYRACUSE, NY 13210-1155
(315) 478-4185
(315) 478-0840
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
302160
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000923428001
HEALTHNOW PROVIDER NUMBER
NY
Enumeration date
11/22/2005
Last updated
06/18/2012
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