Provider Demographics
NPI:1912986159
Name:MOZLOOM, JOANNE PALUMBO (OD)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:PALUMBO
Last Name:MOZLOOM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 MIDDLE SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-5316
Mailing Address - Country:US
Mailing Address - Phone:315-733-2020
Mailing Address - Fax:315-735-3628
Practice Address - Street 1:4350 MIDDLE SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-5316
Practice Address - Country:US
Practice Address - Phone:315-733-2020
Practice Address - Fax:315-735-3628
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005231152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01879267Medicaid
NY55745CMedicare ID - Type Unspecified
NY01879267Medicaid