Healthcare Provider Details

I. General information

NPI: 1598699803
Provider Name (Legal Business Name): JAMAL MOORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 N MAIN ST
MILLBURY MA
01527
US

IV. Provider business mailing address

266 MAIN ST APT 5 UNIT 5
OXFORD MA
01540-2503
US

V. Phone/Fax

Practice location:
  • Phone: 508-506-8940
  • Fax:
Mailing address:
  • Phone: 561-318-4426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: