Individual
MICHAEL K MOORE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
30 PROSPECT AVE, FACULTY PRACTICE OFFICE, HACKENSACK, NJ 07601-1914
(201) 441-3349
Mailing address
46 MADISON AVE, SUMMIT, NJ 07901-1555
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MP000518
NJ
Other
Enumeration date
06/09/2006
Last updated
07/08/2007
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