Healthcare Provider Details

I. General information

NPI: 1255883641
Provider Name (Legal Business Name): MANDY MOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 AMBOY AVE
EDISON NJ
08837-2552
US

IV. Provider business mailing address

10 COMMERCIAL AVE APT 4J
NEW BRUNSWICK NJ
08901-1422
US

V. Phone/Fax

Practice location:
  • Phone: 732-494-0677
  • Fax:
Mailing address:
  • Phone: 917-628-6592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03830100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: