Provider Demographics
NPI:1538750062
Name:MOORE, PAUL HUNDLEY (LP)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:HUNDLEY
Last Name:MOORE
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 DITMAS AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-6921
Mailing Address - Country:US
Mailing Address - Phone:540-818-1310
Mailing Address - Fax:
Practice Address - Street 1:16 W 10TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8707
Practice Address - Country:US
Practice Address - Phone:212-260-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001087102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst