Provider Demographics
NPI:1255409868
Name:MOORESTOWN INTERNAL MEDICINE, P.C.
Entity type:Organization
Organization Name:MOORESTOWN INTERNAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-234-7754
Mailing Address - Street 1:147 E 3RD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2924
Mailing Address - Country:US
Mailing Address - Phone:856-234-7754
Mailing Address - Fax:856-234-2290
Practice Address - Street 1:147 E 3RD ST STE 1
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2924
Practice Address - Country:US
Practice Address - Phone:856-234-7754
Practice Address - Fax:856-234-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ003106OtherAETNA
NJ0500085001OtherAMERIHEALTH KHPE IND BC
NJ4621000Medicaid
NJCI0287OtherRAILROAD MEDICARE
NJCI0287OtherRAILROAD MEDICARE