Provider Demographics
NPI:1184660433
Name:MOSS, VANCE JOSHAUN (MD)
Entity Type:Individual
Prefix:
First Name:VANCE
Middle Name:JOSHAUN
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2356 US HIGHWAY 9
Mailing Address - Street 2:SUITE B6
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-4017
Mailing Address - Country:US
Mailing Address - Phone:732-886-2252
Mailing Address - Fax:732-886-2260
Practice Address - Street 1:2356 US HIGHWAY 9
Practice Address - Street 2:SUITE B6
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-4017
Practice Address - Country:US
Practice Address - Phone:732-886-2252
Practice Address - Fax:732-886-2260
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY231473208800000X
NJ25MA079030002088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02619285Medicaid
NYA400054411Medicare PIN