Basic Information
| Provider Information | |||||||||
| NPI: | 1477579258 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | LES | ||||||||
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| Credential: | N.D.,LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 COULTER RD | ||||||||
| Address2: | ATTN: MEDICAL STAFF OFFICE | ||||||||
| City: | CLIFTON SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144321122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154621464 | ||||||||
| FaxNumber: | 3154622487 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 COULTER RD | ||||||||
| Address2: | THE SPRINGS AT CLIFTON | ||||||||
| City: | CLIFTON SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144321122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154620390 | ||||||||
| FaxNumber: | 3154627784 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 001312 | NY | X | Other Service Providers | Acupuncturist | 175F00000X | 001312 | NY | X | Other Service Providers | Naturopath |
No ID Information.