Provider Demographics
NPI:1942885587
Name:MORAA, BATHSEBA
Entity Type:Individual
Prefix:MS
First Name:BATHSEBA
Middle Name:
Last Name:MORAA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-1706
Mailing Address - Country:US
Mailing Address - Phone:201-626-0080
Mailing Address - Fax:
Practice Address - Street 1:55 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-1706
Practice Address - Country:US
Practice Address - Phone:201-626-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0600471928251E00000X, 251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No251E00000XAgenciesHome Health