Healthcare Provider Details

I. General information

NPI: 1275782310
Provider Name (Legal Business Name): JAIME MOYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2008
Last Update Date: 09/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 JEFFERSON AVE
HASBROUCK HEIGHTS NJ
07604-2631
US

IV. Provider business mailing address

471 JEFFERSON AVE
HASBROUCK HEIGHTS NJ
07604-2631
US

V. Phone/Fax

Practice location:
  • Phone: 201-393-9268
  • Fax:
Mailing address:
  • Phone: 201-393-9268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMA 023442
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: