Healthcare Provider Details

I. General information

NPI: 1235853565
Provider Name (Legal Business Name): CARYN A MOYER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 COUNTY ROAD 520 STE 101
MARLBORO NJ
07746-1085
US

IV. Provider business mailing address

1 GROOM CT
TINTON FALLS NJ
07753-7655
US

V. Phone/Fax

Practice location:
  • Phone: 732-856-5999
  • Fax:
Mailing address:
  • Phone: 908-458-1988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01373400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: