MEDICARE: MR. WILLIAM JOSEPH MORAN JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA2000X	Administrator Registered Nurse	R113499	MD

General Provider Information

NPI Number	:	1134100555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM JOSEPH MORAN JR.

Provider Business Mailing Address
First Line	:	1075 STEPHENSON AVE
Second Line	:	PAHC, ATTN: CREDENTIALS OFFICE
City	:	FORT MONMOUTH
State	:	NJ
Zip	:	07703-5000
Country	:	US
Telephone Number	:	732-532-0182
Fax Number	:	732-532-0194

Provider Business Practice Location Address
First Line	:	1075 STEPHENSON AVE
Second Line	:	PAHC, ATTN: CREDENTIALS OFFICE
City	:	FORT MONMOUTH
State	:	NJ
Zip	:	07703-5000
Country	:	US
Telephone Number	:	732-532-0182
Fax Number	:	732-532-0194

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	07/08/2007

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