Provider Demographics
NPI:1386093920
Name:MOORE, DARREN
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2162 BAYLIS AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2937
Mailing Address - Country:US
Mailing Address - Phone:516-817-8592
Mailing Address - Fax:516-488-0610
Practice Address - Street 1:2162 BAYLIS AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2937
Practice Address - Country:US
Practice Address - Phone:516-817-8592
Practice Address - Fax:516-488-0610
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-04
Last Update Date:2016-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator