Provider Demographics
NPI:1992715387
Name:MOORLEY, MAYA D (MD)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:D
Last Name:MOORLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2779
Mailing Address - Country:US
Mailing Address - Phone:631-351-3810
Mailing Address - Fax:631-351-1890
Practice Address - Street 1:325 PARK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2779
Practice Address - Country:US
Practice Address - Phone:631-351-3810
Practice Address - Fax:631-351-1890
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227555-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3344553OtherOXFORD
NY2516782OtherGHI
NY056SD1OtherBLUE CROSS/ BLUE SHIELD
NY3C6657OtherHEALTHNET
NY02601994Medicaid
NYP3344553OtherOXFORD
NY2516782OtherGHI