Healthcare Provider Details

I. General information

NPI: 1871609149
Provider Name (Legal Business Name): MOISHE STARKMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 ROUTE 130 BLDG C
DELRAN NJ
08075-2414
US

IV. Provider business mailing address

163 US HIGHWAY 130 STE 1B
BORDENTOWN NJ
08505-2249
US

V. Phone/Fax

Practice location:
  • Phone: 856-705-0685
  • Fax: 856-705-0686
Mailing address:
  • Phone: 609-298-2992
  • Fax: 609-291-8359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMA50962
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA05096200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: