MEDICARE: MOONBRIDGEABA-LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1154273365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOONBRIDGEABA-LLC

Provider Business Mailing Address
First Line	:	1122 HARDING RD
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07208-1012
Country	:	US
Telephone Number	:	908-977-0708
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 HARDING RD
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07208-1012
Country	:	US
Telephone Number	:	908-977-0708
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	AILETH ROSALBA ALVERO GARCIA
Credential	:
Telephone Number	:	908-977-0708

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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