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General NPI Number Information
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NPI Number | 1023182359
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Entity Type | Individual
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Provider Name | SANDRA ISAACS MOELLER PHD
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 705 WHITE HORSE PIKE SUITE S - 5A
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City | ABSECON
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State | NJ
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Zip | 08201-1468
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Country | US
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Telephone | 609-383-8566
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Fax | 609-383-8874
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Provider Business Mailing Address
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Address Line | 3413 KENWOOD COURT
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City | MAYS LANDING
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State | NJ
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Zip | 08330-3204
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Country | US
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Telephone | 609-641-1063
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 35SI00273500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0059841
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License Number State | NY
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