1457551442 NPI number — SUSAN I MORENO M.D. P.C.

Table of content: (NPI 1457551442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457551442 NPI number — SUSAN I MORENO M.D. P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN I MORENO M.D. P.C.
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:
1457551442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
196 GROVE AVE
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
THOROFARE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-845-2323
Provider Business Mailing Address Fax Number:
856-845-4888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
196 GROVE AVE
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
THOROFARE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-845-2323
Provider Business Practice Location Address Fax Number:
856-845-4888
Provider Enumeration Date:
07/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MORENO
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
I
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
856-845-2323

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MA05706900 , 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: 0509463000 . This is a "KEYSTONE, AMERI, BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2162090 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 905513 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1697844001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: G22323 . This is a "AMERI HEALTH ADMIN." identifier . This identifiers is of the category "OTHER".
  • Identifier: 0558269000 . This is a "AMERIIHEALTH PERSONAL CHO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 722323 . This is a "PABS PC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 722323 . This is a "AMERIHEALTH PC" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2681709 . This is a "OXFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 722323 . This is a "HORIZON BC/BS NJ" identifier . This identifiers is of the category "OTHER".




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