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General NPI Number Information
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NPI Number | 1609685007
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Entity Type | Organization
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Legal Business Name | MOONA MEDICAL GROUP OF NEW JERSEY PC
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Dates
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Enumeration Date | 01/01/2025
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Last Update Date | 01/01/2025
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Provider Practice Location Address
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Address Line | 221 RIVER ST STE 9
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City | HOBOKEN
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State | NJ
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Zip | 07030-5990
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Country | US
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Telephone | 503-427-8095
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Fax |
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Provider Business Mailing Address
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Address Line | 221 RIVER ST STE 9
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City | HOBOKEN
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State | NJ
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Zip | 07030-5990
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | PAUL DESCHAMPS
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Credential |
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Telephone | 503-427-8095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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