Provider Demographics
NPI:1548617103
Name:MORALES, JOSE ANDRES
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ANDRES
Last Name:MORALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 ROSEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-2425
Mailing Address - Country:US
Mailing Address - Phone:973-493-4239
Mailing Address - Fax:
Practice Address - Street 1:541 ROSEVILLE AV.
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107
Practice Address - Country:US
Practice Address - Phone:973-493-4239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator