Healthcare Provider Details

I. General information

NPI: 1972878239
Provider Name (Legal Business Name): DOVID SIMCHA MORADI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 DICKINSON ST
ELIZABETH NJ
07201-2210
US

IV. Provider business mailing address

520 N WOOD AVE
LINDEN NJ
07036-4147
US

V. Phone/Fax

Practice location:
  • Phone: 908-354-8900
  • Fax:
Mailing address:
  • Phone: 908-587-9300
  • Fax: 908-587-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA10051300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: