MEDICARE: WALGREENS HEALTH MEDICAL GROUP NEW JERSEY P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1427749662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREENS HEALTH MEDICAL GROUP NEW JERSEY P.C.

Provider Business Mailing Address
First Line	:	108 WILMOT RD
Second Line	:
City	:	DEERFIELD
State	:	IL
Zip	:	60015-5145
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	899 MOUNTAIN AVE
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-3455
Country	:	US
Telephone Number	:	312-399-6989
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SASHIDARAN MOODLEY
Credential	:	M.D.
Telephone Number	:	312-982-1242

Provider Enumeration Date	:	05/18/2023
Last Update Date	:	01/16/2026

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