Healthcare Provider Details

I. General information

NPI: 1336294594
Provider Name (Legal Business Name): THE MOSS & GEUDER SURGICAL GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE SUITE 707
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

20 PROSPECT AVE SUITE 707
HACKENSACK NJ
07601-1997
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-2220
  • Fax: 201-343-9106
Mailing address:
  • Phone: 201-488-2220
  • Fax: 201-343-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHARLES M MOSS
Title or Position: PRESIDENT
Credential: MD
Phone: 201-488-2220