Organization
J. G. MORENO, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE G MORENO M.D. (OWNER)
(973) 966-0072
Entity
Organization
Contact information
Practice address
205 RIDGEDALE AVE, FLORHAM PARK, NJ 07932-1349
(973) 966-0072
(908) 879-5009
Mailing address
205 RIDGEDALE AVE, FLORHAM PARK, NJ 07932-1349
(973) 966-0072
(908) 879-5009
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
25MA03554300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3449807
—
NJ
01
—
461207
MEDICARE PTAN
NJ
Enumeration date
12/15/2009
Last updated
12/15/2009
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