Provider Demographics
NPI:1205573607
Name:JEAN-NOEL, MOZARD
Entity type:Individual
Prefix:
First Name:MOZARD
Middle Name:
Last Name:JEAN-NOEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 BALMORAL AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5204
Mailing Address - Country:US
Mailing Address - Phone:973-715-3961
Mailing Address - Fax:
Practice Address - Street 1:2228 BALMORAL AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5204
Practice Address - Country:US
Practice Address - Phone:973-715-3961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR500-PA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical