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General NPI Number Information
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NPI Number | 1740744481
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Entity Type | Organization
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Legal Business Name | TAEWON MOON M.D. PA
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Dates
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Enumeration Date | 01/28/2019
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Last Update Date | 01/28/2019
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Provider Practice Location Address
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Address Line | 464 HUDSON TERRACE SUITE 102
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2917
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Country | US
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Telephone | 201-503-0066
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Fax | 201-503-0190
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Provider Business Mailing Address
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Address Line | 464 HUDSON TERRACE SUITE 102
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2917
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Country | US
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Telephone | 201-503-0066
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Fax | 201-503-0190
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAEWON MOON
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Credential | MD
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Telephone | 201-503-0066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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