Healthcare Provider Details

I. General information

NPI: 1972578532
Provider Name (Legal Business Name): ANNA MOY DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 NYE AVE STE A7
IRVINGTON NJ
07111
US

IV. Provider business mailing address

PO BOX 3619
JERSEY CITY NJ
07303-3619
US

V. Phone/Fax

Practice location:
  • Phone: 973-416-1333
  • Fax: 973-416-0179
Mailing address:
  • Phone: 201-938-1866
  • Fax: 973-416-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD00155900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: