Active NPI
Michael C Moore, PTA
- Physical Therapy Assistant
- Oakdale, NY
National Provider Identifier
1366005282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 010896-1
- Practice address
- 305 Locust Ave
Oakdale, NY 11769-1652 - Phone
- (631) 218-5900
- NPI assigned
- Apr 16, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 010896-1 | NY | Primary |
Addresses
Primary practice location
305 Locust Ave
Oakdale, NY 11769-1652
Mailing address
38 Seminole Dr
Commack, NY 11725-4625
Phone (917) 716-5572
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010896-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555372800000",
"number": "1366005282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38 SEMINOLE DR",
"city": "COMMACK",
"state": "NY",
"postal_code": "117254625",
"telephone_number": "917-716-5572"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 LOCUST AVE",
"city": "OAKDALE",
"state": "NY",
"postal_code": "117691652",
"telephone_number": "631-218-5900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "MICHAEL",
"middle_name": "C",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-04-16",
"last_updated": "2019-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NY",
"license": "010896-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakdale, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.