Timothy W. Moon,DO, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

224227 Issued in NY

Legal business name

TIMOTHY W. MOON,DO, PLLC

Practice address

77 W Barney St
Gouverneur, NY 13642-1040

Phone

(315) 287-3285

Fax

(315) 287-3280

NPI assigned

Apr 27, 2007

Last updated

Nov 10, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Timothy W. Moon, D.O.

Title

President

Phone

(315) 486-2987

Specialties & licenses 1

Addresses

Other identifiers 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Nephrology Associates of Watertown PC

  • Nephrology Physician
  • Watertown, NY
  • NPI 1861432304

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320883200000",
    "number": "1194945410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 W BARNEY ST",
            "city": "GOUVERNEUR",
            "state": "NY",
            "postal_code": "136421040",
            "telephone_number": "315-287-3285",
            "fax_number": "315-287-3280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 W BARNEY ST",
            "city": "GOUVERNEUR",
            "state": "NY",
            "postal_code": "136421040",
            "telephone_number": "315-287-3285",
            "fax_number": "315-287-3280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY W. MOON,DO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-27",
        "last_updated": "2011-11-10",
        "status": "A",
        "authorized_official_last_name": "MOON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "315-486-2987",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "224227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02501733",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Terpstra
• Michelle Tharrett
• Emily C Thomas
• Amy Jo Thorbahn, RN,BSN
• Neil Robert Tierson, PHARMD, RPH
• Mark Daniel Truax, D.D.S.
• Tina L Walrath, LPN
• Watertown Medical Optical PLLC
• John L Welborn IV, FNP-C
• Todd M Wells, PHARMD

• Family Medicine Physician in Gouverneur, NY
• Providers in Gouverneur, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.