=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396270518
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOONLIGHT PEDIATRICS URGENT CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2017
-----------------------------------------------------
Last Update Date | 04/25/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 MANDARIN CT
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-3900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-364-5437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 MANDARIN CT
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-3900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDIATRICIAN/OWNER
-----------------------------------------------------
Name | GIUSEPPINA FEINGOLD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 732-364-5437
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number | 26NJ00725700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------