Individual
ILENE M MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
11 SADDLE RD, CEDAR KNOLLS, NJ 07927-1901
(973) 267-2122
(973) 292-1466
Mailing address
PO BOX 416457, BOSTON, MA 02241-6457
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
25MB05693500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7185103
—
NJ
Enumeration date
07/06/2006
Last updated
06/12/2012
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