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General NPI Number Information
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NPI Number | 1225302466
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Entity Type | Organization
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Legal Business Name | MOSS UROLOGIC SURGERY, LLC
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 2356 ROUTE 9 SOUTH SUITE B6
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City | HOWELL
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State | NJ
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Zip | 07731
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Country | US
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Telephone | 732-886-2252
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Fax | 732-886-2260
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Provider Business Mailing Address
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Address Line | 2356 ROUTE 9 STE B6
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City | HOWELL
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State | NJ
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Zip | 07731-4017
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Country | US
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Telephone | 732-886-2252
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Fax | 732-886-2260
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Authorized Official
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Title or Position | OWNER
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Name | VANCE JOSHAUN MOSS
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Credential | MD
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Telephone | 732-886-2252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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