MEDICARE: DR. GREGORY HERBERT MOORE PSY.D.

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	103TF0000X	Family Psychologist	2833	NJ

General Provider Information

NPI Number	:	1619991411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY HERBERT MOORE PSY.D.

Provider Business Mailing Address
First Line	:	231 CLARKSVILLE RD
Second Line	:	SUITE 7-A
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-5300
Country	:	US
Telephone Number	:	609-275-8808
Fax Number	:	609-275-9655

Provider Business Practice Location Address
First Line	:	231 CLARKSVILLE RD
Second Line	:	SUITE 7-A
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-5300
Country	:	US
Telephone Number	:	609-275-8808
Fax Number	:	609-275-9655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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