Provider Demographics
NPI:1386680783
Name:MOORE, JUDITH CLAIR (CPNP)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:CLAIR
Last Name:MOORE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3889 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454
Mailing Address - Country:US
Mailing Address - Phone:585-243-4000
Mailing Address - Fax:585-243-4002
Practice Address - Street 1:3889 NORTH RD
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454
Practice Address - Country:US
Practice Address - Phone:585-243-4000
Practice Address - Fax:585-243-4002
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3807831208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
109424DLOtherPFC
02258175OtherMED