Provider Demographics
NPI:1326059270
Name:MOELLER, JOSEPH PHILLIP (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PHILLIP
Last Name:MOELLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 SPRINGDALE RD STE A3
Mailing Address - Street 2:PMB 412
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3360
Mailing Address - Country:US
Mailing Address - Phone:856-616-8777
Mailing Address - Fax:856-616-8780
Practice Address - Street 1:100 SPRINGDALE RD STE A3
Practice Address - Street 2:PMB 412
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3360
Practice Address - Country:US
Practice Address - Phone:856-616-8777
Practice Address - Fax:856-616-8780
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0118992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012899720001Medicaid
PAI26885Medicare UPIN
PA1012899720001Medicaid