Healthcare Provider Details

I. General information

NPI: 1073614327
Provider Name (Legal Business Name): HARRIS IRA MOORE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 BERGENLINE AVE
WEST NEW YORK NJ
07093-1448
US

IV. Provider business mailing address

102 EDGEWATER RD
CLIFFSIDE PARK NJ
07010-2900
US

V. Phone/Fax

Practice location:
  • Phone: 201-758-0099
  • Fax:
Mailing address:
  • Phone: 732-586-5541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC02163
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: