Healthcare Provider Details

I. General information

NPI: 1306074570
Provider Name (Legal Business Name): JAMES P MOONEY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAMES P. MOONEY M.D.

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 TIMBERLANE DR
ORANGE CT
06477-2845
US

IV. Provider business mailing address

352 TIMBERLANE DR
ORANGE CT
06477-2845
US

V. Phone/Fax

Practice location:
  • Phone: 203-795-3986
  • Fax: 203-795-9849
Mailing address:
  • Phone: 203-795-3986
  • Fax: 203-795-9849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number8412
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number8412
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: