Provider Demographics
NPI:1134100555
Name:MORAN, WILLIAM JOSEPH JR
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:MORAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 STEPHENSON AVE
Mailing Address - Street 2:PAHC, ATTN: CREDENTIALS OFFICE
Mailing Address - City:FORT MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07703-5000
Mailing Address - Country:US
Mailing Address - Phone:732-532-0182
Mailing Address - Fax:732-532-0194
Practice Address - Street 1:1075 STEPHENSON AVE
Practice Address - Street 2:PAHC, ATTN: CREDENTIALS OFFICE
Practice Address - City:FORT MONMOUTH
Practice Address - State:NJ
Practice Address - Zip Code:07703-5000
Practice Address - Country:US
Practice Address - Phone:732-532-0182
Practice Address - Fax:732-532-0194
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR113499163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator