Healthcare Provider Details

I. General information

NPI: 1780595967
Provider Name (Legal Business Name): AVALORA MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 WHITE RD
JACKSON NJ
08527-5008
US

IV. Provider business mailing address

79 WHITE RD
JACKSON NJ
08527-5008
US

V. Phone/Fax

Practice location:
  • Phone: 732-942-2988
  • Fax:
Mailing address:
  • Phone: 732-942-2988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MOSHE ROSE
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 732-942-2988