Provider Demographics
NPI:1033103429
Name:MOYNIHAN, NATALIE JEAN (MS APRN BC CS)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:JEAN
Last Name:MOYNIHAN
Suffix:
Gender:F
Credentials:MS APRN BC CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-2923
Mailing Address - Country:US
Mailing Address - Phone:732-246-2849
Mailing Address - Fax:732-246-4264
Practice Address - Street 1:4 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-2923
Practice Address - Country:US
Practice Address - Phone:732-246-2849
Practice Address - Fax:732-246-4264
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC02602100364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6670105Medicaid
NJ6670105Medicaid
P20516Medicare UPIN