Provider Demographics
NPI:1124433362
Name:MOORE, STEPHEN D (RN)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:MOORE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W 57TH ST
Mailing Address - Street 2:APT. 611
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3159
Mailing Address - Country:US
Mailing Address - Phone:212-645-5812
Mailing Address - Fax:212-974-3045
Practice Address - Street 1:333 W 57TH ST
Practice Address - Street 2:APT. 611
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3159
Practice Address - Country:US
Practice Address - Phone:212-645-5812
Practice Address - Fax:212-974-3045
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY614183163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health