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General NPI Number Information
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NPI Number | 1790785921
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Entity Type | Individual
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Provider Name | MOISES KAWEBLUM M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 1 LUCERNE DR
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City | LAKEWOOD
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State | NJ
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Zip | 08701-2135
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Country | US
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Telephone | 732-722-7593
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Fax | 732-722-7593
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Provider Business Mailing Address
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Address Line | 1 LUCERNE DR
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City | LAKEWOOD
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State | NJ
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Zip | 08701-2135
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Country | US
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Telephone | 732-722-7593
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Fax | 888-965-2286
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 25MA07181100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 25MA07181100
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 25MA07181100
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License Number State | NJ
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