Sam Eugene Moore Jr., AMBULETTE

Primary specialty

DriverTaxonomy code 172A00000X

License

5363887522 Issued in NY

Practice address

33 Du Bois Ave
Poughkeepsie, NY 12601-2140

Phone

(845) 464-4162

NPI assigned

Jan 28, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1580169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580169600000",
    "number": "1306477518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 DU BOIS AVE",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126012140",
            "telephone_number": "845-464-4162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 DU BOIS AVE",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126012140",
            "telephone_number": "845-464-4162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SAM",
        "middle_name": "EUGENE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "AMBULETTE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-28",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Driver",
            "state": "NY",
            "license": "5363887522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "ABOVEBEYOND",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "COMPUTER",
            "address_1": "33 Du Bois Ave",
            "city": "Poughkeepsie",
            "state": "NY",
            "country_code": "US",
            "postal_code": "126012140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristin Montini, MSW
• Montrose Vamc
• Ellen Elizabeth Moore, M.S.; CCC-SLP
• Gwendolyn L Moore
• Marisa M. Moore, PHD
• Sarah Elizabeth Moore, CASAC-2
• Nikhilendhar Nag Mopuru
• Isabella R Mora, DC
• Lilybeth Morales, MD
• Heather Julia Moran

• Driver in Poughkeepsie, NY
• Providers in Poughkeepsie, NY by specialty
• Driver in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; 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.