Healthcare Provider Details

I. General information

NPI: 1437223161
Provider Name (Legal Business Name): CARLOS MORA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 STEPHEN STREET
MONTCLAIR NJ
07042-5032
US

IV. Provider business mailing address

26 STEPHEN STREET
MONTCLAIR NJ
07042-5032
US

V. Phone/Fax

Practice location:
  • Phone: 973-509-2408
  • Fax: 973-509-2408
Mailing address:
  • Phone: 973-509-2408
  • Fax: 973-509-2408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number25MA08053200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0197502
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: