Provider Demographics
NPI:1427424829
Name:MORIARTY, AIMEE MICHELLE (PA)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:MICHELLE
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:MICHELLE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1555 LONG POND RD
Mailing Address - Street 2:DEPARTMENT OF SURGERY
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7281
Mailing Address - Fax:585-723-8660
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4164
Practice Address - Country:US
Practice Address - Phone:585-723-7281
Practice Address - Fax:585-723-8660
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018915363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400249332-GRPBA0017Medicare PIN
NYJ400249336-GRP70008AMedicare PIN