Provider Demographics
NPI:1225393564
Name:MOORE, ANDREA C (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:C
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:C
Other - Last Name:DURYEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:755 MEMORIAL PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2748
Mailing Address - Country:US
Mailing Address - Phone:908-847-8884
Mailing Address - Fax:833-204-9604
Practice Address - Street 1:755 MEMORIAL PKWY STE 201
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2748
Practice Address - Country:US
Practice Address - Phone:908-847-8884
Practice Address - Fax:833-204-9604
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA05528363AS0400X
NJ25MP00285200363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ244824Medicare PIN