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General NPI Number Information
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NPI Number | 1831143718
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Entity Type | Individual
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Provider Name | JACQUELINE S MOSS DO
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Gender | Female
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 04/24/2015
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Provider Practice Location Address
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Address Line | 226 NORHAMPTON STREET
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City | EASTON
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State | PA
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Zip | 18042-3676
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Country | US
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Telephone | 484-221-9136
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Fax | 484-221-9130
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Provider Business Mailing Address
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Address Line | 2030 TIGHMAN STREET SUITE 105B
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City | ALLENTOWN
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State | PA
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Zip | 18104-4354
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Country | US
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Telephone | 484-221-9136
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Fax | 484-221-9130
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | OS9075
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License Number State | FL
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