Provider Demographics
NPI:1790329746
Name:MOISE, JOSEPH DURKHEIM (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DURKHEIM
Last Name:MOISE
Suffix:
Gender:M
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-5828
Mailing Address - Country:US
Mailing Address - Phone:908-986-6071
Mailing Address - Fax:
Practice Address - Street 1:115 HORIZON DR
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-5828
Practice Address - Country:US
Practice Address - Phone:908-986-6071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-02
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR353-P.A.363A00000X
NYF351735-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant