Healthcare Provider Details

I. General information

NPI: 1932348281
Provider Name (Legal Business Name): MOON ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3634 MAGAZINE ST
NEW ORLEANS LA
70115-2554
US

IV. Provider business mailing address

3634 MAGAZINE ST
NEW ORLEANS LA
70115-2554
US

V. Phone/Fax

Practice location:
  • Phone: 504-267-5276
  • Fax: 504-391-0124
Mailing address:
  • Phone: 504-267-5276
  • Fax: 504-391-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number149623
License Number StateLA

VIII. Authorized Official

Name: MR. JOHN E MOON
Title or Position: OWNER
Credential: CPO
Phone: 504-391-9141