Healthcare Provider Details

I. General information

NPI: 1356404230
Provider Name (Legal Business Name): SCOTT BENNETT MOSES DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 W MAIN ST
DENVILLE NJ
07834-1213
US

IV. Provider business mailing address

279 W MAIN ST
DENVILLE NJ
07834-1213
US

V. Phone/Fax

Practice location:
  • Phone: 973-625-5300
  • Fax: 973-625-7537
Mailing address:
  • Phone: 973-625-5300
  • Fax: 973-625-7537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number29V100195100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: