Basic Information
| Provider Information | |||||||||
| NPI: | 1982856191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | CLAUDIA | ||||||||
| MiddleName: | CONTESS | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
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| OtherOrganizationType: | |||||||||
| OtherLastName: | CONTESS | ||||||||
| OtherFirstName: | CLAUDIA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 435 4TH ST | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121805324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182716777 | ||||||||
| FaxNumber: | 5182745438 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 4TH ST | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121805324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182716777 | ||||||||
| FaxNumber: | 5182745438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2008 | ||||||||
| LastUpdateDate: | 09/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 0056921 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 03641476 | 05 | NY | MEDICAID |