1841928546 NPI number — QUASERIA MOSS

Table of content: QUASERIA MOSS (NPI 1841928546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841928546 NPI number — QUASERIA MOSS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSS
Provider First Name:
QUASERIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1841928546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 TORY JACK TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
S BOUND BROOK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08880-1496
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-685-6002
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 ROBERT WOOD JOHNSON PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08901-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-253-3216
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LC0200X , with the licence number:  26NJ01318000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: 26NJ01318000 , 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)