Healthcare Provider Details

I. General information

NPI: 1184660433
Provider Name (Legal Business Name): VANCE JOSHAUN MOSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2356 US HIGHWAY 9 SUITE B6
HOWELL NJ
07731-4017
US

IV. Provider business mailing address

2356 US HIGHWAY 9 SUITE B6
HOWELL NJ
07731-4017
US

V. Phone/Fax

Practice location:
  • Phone: 732-886-2252
  • Fax: 732-886-2260
Mailing address:
  • Phone: 732-886-2252
  • Fax: 732-886-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number231473
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number25MA07903000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: