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General NPI Number Information
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NPI Number | 1902559446
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Entity Type | Individual
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Provider Name | MARYANN MOYLAN RD
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Gender | Female
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 755 MEMORIAL PKWY STE 302A
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City | PHILLIPSBURG
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State | NJ
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Zip | 08865-2771
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Country | US
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Telephone | 908-847-2050
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Fax | 866-449-5832
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Provider Business Mailing Address
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Address Line | 5426 TRUTH PL
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City | ALLENTOWN
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State | PA
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Zip | 18106-8708
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Country | US
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Telephone | 610-391-9305
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Fax |
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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