Healthcare Provider Details

I. General information

NPI: 1821149451
Provider Name (Legal Business Name): MARNELL PAUL MOORE D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CENTRAL AVE STE 301
EAST ORANGE NJ
07018-2838
US

IV. Provider business mailing address

310 CENTRAL AVE STE 301
EAST ORANGE NJ
07018-2838
US

V. Phone/Fax

Practice location:
  • Phone: 973-337-2893
  • Fax: 201-228-1689
Mailing address:
  • Phone: 973-337-2893
  • Fax: 201-228-1689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00289000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00289000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: