Healthcare Provider Details

I. General information

NPI: 1336532779
Provider Name (Legal Business Name): MATTHEW MAN-YU MOY DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 NEWARK AVE STE 500
JERSEY CITY NJ
07302-5873
US

IV. Provider business mailing address

17 AVE AT PORT IMPERIAL APT 1016
WEST NEW YORK NJ
07093-7043
US

V. Phone/Fax

Practice location:
  • Phone: 201-565-0409
  • Fax:
Mailing address:
  • Phone: 508-208-2943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number22DI02611300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI02611300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: