Healthcare Provider Details

I. General information

NPI: 1942420419
Provider Name (Legal Business Name): MOISE JOSEPH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 W GLENDALE AVE E119
PHOENIX AZ
85051-8194
US

IV. Provider business mailing address

PO BOX 530077
ATLANTA GA
30353-0077
US

V. Phone/Fax

Practice location:
  • Phone: 623-915-0270
  • Fax: 623-915-4837
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number58793
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number33517
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: