Healthcare Provider Details

I. General information

NPI: 1184675936
Provider Name (Legal Business Name): MRS. KERI LYNN MORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STORE 100 COPPERTREE MALL
OAKLAND NJ
07436
US

IV. Provider business mailing address

42 KINDERKAMACK RD
PARK RIDGE NJ
07656-2131
US

V. Phone/Fax

Practice location:
  • Phone: 201-264-2322
  • Fax:
Mailing address:
  • Phone: 201-746-0133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberQA00832000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: