Individual provider · Type 1 NPI

Ji Soo Moon, AG-ACNP

Acute Care Nurse Practitioner · Forest Hills, NY

NPI number 1043804255 Active

Practice location

10201 66th Rd
Forest Hills, NY 11375-2029

Mailing address

55 Lake Ave N
Worcester, MA 01655-0002

Other practice locations

  • 55 Lake Ave N, Worcester, MA 01655-0002 · (508) 334-1000

Specialties and licenses

TaxonomyCodeLicense
Acute Care Nurse Practitioner 363LA2100XRN2324806 (MA)
Acute Care Nurse Practitioner Primary 363LA2100XF432459-01 (NY)

Acute Care Nurse Practitioner: Definition to come...

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About NPI 1043804255

Ji Soo Moon, AG-ACNP's National Provider Identifier is 1043804255, issued on Feb 28, 2021. The primary taxonomy on file is Acute Care Nurse Practitioner (363LA2100X), and the practice location is in Forest Hills, NY. The record was last updated on Jul 13, 2023.