Provider Demographics
NPI:1376791566
Name:MOSS, SANDRA W (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:W
Last Name:MOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 EGGERT AVE
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2505
Mailing Address - Country:US
Mailing Address - Phone:732-549-5843
Mailing Address - Fax:
Practice Address - Street 1:33 EGGERT AVE
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2505
Practice Address - Country:US
Practice Address - Phone:732-549-5843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-31
Last Update Date:2008-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02675900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine