MEDICARE: BRIAN JOSEPH MOORE M.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	207R00000X	Internal Medicine Physician	MA33681	NJ

General Provider Information

NPI Number	:	1952480063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN JOSEPH MOORE M.D.

Provider Business Mailing Address
First Line	:	1201 MOUNT KEMBLE AVE
Second Line	:
City	:	MORRISTOWN
State	:	NJ
Zip	:	07960-6628
Country	:	US
Telephone Number	:	908-766-0904
Fax Number	:	908-766-5827

Provider Business Practice Location Address
First Line	:	1201 MOUNT KEMBLE AVE
Second Line	:
City	:	MORRISTOWN
State	:	NJ
Zip	:	07960-6628
Country	:	US
Telephone Number	:	908-766-0904
Fax Number	:	908-766-5827

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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