Active NPI
Kimberly Moore, MS, CCC-SLP
- Speech-Language Pathologist
- Monroe, NY
National Provider Identifier
1316190887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 018101-1
- Practice address
- 10 Cunningham Dr
Monroe, NY 10950-3906 - Phone
- (845) 782-8368
- NPI assigned
- Oct 28, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 018101-1 | NY | Primary |
Addresses
Primary practice location
10 Cunningham Dr
Monroe, NY 10950-3906
Mailing address
10 Cunningham Dr
Monroe, NY 10950-3906
Phone (845) 782-8368
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 252YOOOOOX | Other | NY | ALL OTHER EI SERVICES |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 018101-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339718400000",
"number": "1316190887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 CUNNINGHAM DR",
"city": "MONROE",
"state": "NY",
"postal_code": "109503906",
"telephone_number": "845-782-8368"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 CUNNINGHAM DR",
"city": "MONROE",
"state": "NY",
"postal_code": "109503906",
"telephone_number": "845-782-8368"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "KIMBERLY",
"credential": "MS, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-28",
"last_updated": "2012-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "018101-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALL OTHER EI SERVICES",
"identifier": "252YOOOOOX",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Monroe, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.