Provider Demographics
NPI:1609245893
Name:SUSAN MOORE
Entity Type:Organization
Organization Name:SUSAN MOORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FITNESS CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:732-539-4921
Mailing Address - Street 1:14 HEATHER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-2630
Mailing Address - Country:US
Mailing Address - Phone:732-539-4921
Mailing Address - Fax:
Practice Address - Street 1:14 HEATHER VALLEY RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:18966-2630
Practice Address - Country:US
Practice Address - Phone:732-539-4921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health