| Timothy W. Moon,do, Pllc | |
|
77 W Barney St Gouverneur NY 13642-1040 | |
| (315) 287-3285 | |
| (315) 287-3280 |
| Full Name | Timothy W. Moon,do, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 77 W Barney St, Gouverneur, New York |
| Authorized Official Name and Position | Timothy W. Moon (PRESIDENT) |
| Authorized Official Contact | 3154862987 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Timothy W. Moon,do, Pllc 77 W Barney St Gouverneur NY 13642-1040 Ph: (315) 287-3285 | Timothy W. Moon,do, Pllc 77 W Barney St Gouverneur NY 13642-1040 Ph: (315) 287-3285 |
| NPI Number | 1194945410 |
|---|---|
| Provider Enumeration Date | 04/27/2007 |
| Last Update Date | 11/10/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194945410 | NPI | - | NPPES |
| 02501733 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 224227 (New York) | Primary |
Abdur R Jalazai Md Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 63 West Barney St, Gouverneur, NY 13642 Phone: 315-287-1770 Fax: 315-287-1170 | |
Gouverneur Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8 Church St, Gouverneur, NY 13642 Phone: 315-287-1000 |