1750480802 NPI number — DR. SUSAN I MORENO MD

Table of content: DR. SUSAN I MORENO MD (NPI 1750480802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750480802 NPI number — DR. SUSAN I MORENO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORENO
Provider First Name:
SUSAN
Provider Middle Name:
I
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1750480802
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
196 GROVE AVE SUITE E
Provider Second Line Business Mailing Address:
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 SUITE E
Provider Second Line Business Practice Location Address:
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:
09/22/2006

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: 208100000X , 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: 722323 . This is a "AMERIHEALTH PC" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2681709 . This is a "OXFORD HEALTH PLAN NOT IN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004117179 . This is a "FAMILY HEALTH PROV SELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 363879700 . This is a "DEPT OF LABOR WORKMANS CO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 722323 . This is a "PABS PC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1697844001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2162090 . This is a "AETNA IN NETWORK WITH OPE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223671610 . This is a "DEVON" identifier . This identifiers is of the category "OTHER".
  • Identifier: G22323 . This is a "AMERI ADMIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1K8338 . This is a "HEALTHNET HMO PLANS ALSO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 250012005 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 363879700 . This is a "ACS DOL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 722323 . This is a "HORINZON BCBS NJ DIRECT A" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0509463000 . This is a "KEYSTONE AMERI BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 905513 . This is a "FIRSH HEALTH" identifier . This identifiers is of the category "OTHER".




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