Provider Demographics
NPI:1699745034
Name:MORIARTY, ROBERT V (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:V
Last Name:MORIARTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 NEW YORK AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-423-2663
Mailing Address - Fax:631-426-4715
Practice Address - Street 1:755 NEW YORK AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4240
Practice Address - Country:US
Practice Address - Phone:631-423-2663
Practice Address - Fax:631-426-4715
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166856207X00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2219611OtherAETNA
NY12F901OtherBCBS
NY2C8076OtherHEALTHNET
NYCS479OtherOXFORD
NYCS479OtherOXFORD