Provider Demographics
NPI:1568564102
Name:MOQUETE, MANUEL JOAQUIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:JOAQUIN
Last Name:MOQUETE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:246 HAMBURG TPKE STE 207
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2160
Mailing Address - Country:US
Mailing Address - Phone:973-653-3366
Mailing Address - Fax:973-653-3365
Practice Address - Street 1:246 HAMBURG TPKE STE 207
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2160
Practice Address - Country:US
Practice Address - Phone:973-653-3366
Practice Address - Fax:973-653-3365
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61179207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP1030791OtherOXFORD
NJ1042675OtherHORIZON NJ HEALTH
NJ8215828OtherGHI
NJCC8414OtherRAIL ROAD MEDICARE
NJ5982636OtherAETNA
NJ0072037000OtherAMERIHEALTH
NJ1996571OtherUNITED HEALTHCARE
NJ52769OtherAMERIGROUP
NJ6838405Medicaid
NJ01000777000OtherAMERICHOICE
NJ0329258OtherCIGNA
NJ2K9275OtherHEALTHNET
NJ8215828OtherGHI
NJG22809Medicare UPIN