Provider Demographics
NPI:1659655058
Name:MOONEY, JUSTENE L (NP)
Entity Type:Individual
Prefix:
First Name:JUSTENE
Middle Name:L
Last Name:MOONEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3548 ROUTE 9
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857
Mailing Address - Country:US
Mailing Address - Phone:732-679-6300
Mailing Address - Fax:732-679-9566
Practice Address - Street 1:3548 ROUTE 9 STE 2
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2765
Practice Address - Country:US
Practice Address - Phone:732-679-6300
Practice Address - Fax:732-679-9566
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12434600163W00000X
NJ26NJ00344400363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ230800ZURNMedicare PIN