Provider Demographics
NPI:1407857907
Name:MORITZ, JACQUES L (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:L
Last Name:MORITZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 95000-2243
Mailing Address - Street 2:OBGYN ASSOCIATES OF SLR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2243
Mailing Address - Country:US
Mailing Address - Phone:516-338-5300
Mailing Address - Fax:516-338-1075
Practice Address - Street 1:315 W 57TH ST
Practice Address - Street 2:STE 204
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3158
Practice Address - Country:US
Practice Address - Phone:212-603-4160
Practice Address - Fax:212-523-4166
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-01-30
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Provider Licenses
StateLicense IDTaxonomies
NY188159-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01557799Medicaid
NY01557799Medicaid
NYF94990Medicare UPIN