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General NPI Number Information
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NPI Number | 1922680271
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Entity Type | Individual
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Provider Name | MOJAN MOGHADDAM
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Gender | Female
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 20 S VALLEY RD
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City | WEST ORANGE
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State | NJ
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Zip | 07052-4428
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Country | US
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Telephone | 413-356-0894
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Fax |
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Provider Business Mailing Address
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Address Line | 270 10TH ST APT 710
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City | JERSEY CITY
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State | NJ
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Zip | 07302-1336
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Country | US
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Telephone | 413-356-0894
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI04158100
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License Number State | NJ
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