Provider Demographics
NPI:1942093117
Name:MOORE, NIYAH ARIANE (NP)
Entity type:Individual
Prefix:MRS
First Name:NIYAH
Middle Name:ARIANE
Last Name:MOORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 JOHNSON AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2364
Mailing Address - Country:US
Mailing Address - Phone:347-409-4431
Mailing Address - Fax:
Practice Address - Street 1:1601 JOHNSON AVE APT 10
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2364
Practice Address - Country:US
Practice Address - Phone:347-409-4431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY421803363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health