MEDICARE: DR. JEREMY MOON M.D.

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	207V00000X	Obstetrics & Gynecology Physician	25MA08724700	NJ
2	207V00000X	Obstetrics & Gynecology Physician	253835	NY

General Provider Information

NPI Number	:	1831320605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY MOON M.D.

Provider Business Mailing Address
First Line	:	609 WASHINGTON ST
Second Line	:
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-4907
Country	:	US
Telephone Number	:	201-659-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 WASHINGTON ST
Second Line	:
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-4907
Country	:	US
Telephone Number	:	201-659-7700
Fax Number	:

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

Provider Enumeration Date	:	07/28/2009
Last Update Date	:	04/23/2013

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