=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437063807
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. CLEODIS MOBLEY JR.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2026
-----------------------------------------------------
Last Update Date | 10/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 971 US HIGHWAY 202 N # 7716
-----------------------------------------------------
City | BRANCHBURG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08876-3757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-723-2894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 971 US HIGHWAY 202 N # 7716
-----------------------------------------------------
City | BRANCHBURG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08876-3757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-723-2894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number | M60261310008702
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------