1346445376 NPI number — DR ANNA MOY DPM LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346445376 NPI number — DR ANNA MOY DPM LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR ANNA MOY DPM LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346445376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3619
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JERSEY CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07303-3619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-938-1866
Provider Business Mailing Address Fax Number:
973-416-0179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
631 NYE AVE
Provider Second Line Business Practice Location Address:
SUITE A7
Provider Business Practice Location Address City Name:
IRVINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07111-2394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-416-1333
Provider Business Practice Location Address Fax Number:
973-416-0179
Provider Enumeration Date:
06/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOY
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR OF PODIATRIC MEDICINE
Authorized Official Telephone Number:
973-416-1333

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  MD00155900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1972578532 . This is a "INDIVIDUAL NPI #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0313301 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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