Healthcare Provider Details

I. General information

NPI: 1396799565
Provider Name (Legal Business Name): VINCENT LAVAUGHN MOSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 REHILL AVE STE 3400
SOMERVILLE NJ
08876-2548
US

IV. Provider business mailing address

30 REHILL AVE STE 3400
SOMERVILLE NJ
08876-2548
US

V. Phone/Fax

Practice location:
  • Phone: 908-725-2400
  • Fax: 908-927-8990
Mailing address:
  • Phone: 908-725-2400
  • Fax: 908-927-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD428666
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number25MA08002700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: