Provider Demographics
NPI:1255580858
Name:MOISE, GAETAN (MD)
Entity type:Individual
Prefix:DR
First Name:GAETAN
Middle Name:
Last Name:MOISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E. RIDGEWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-327-8600
Mailing Address - Fax:201-327-8225
Practice Address - Street 1:1200 E. RIDGEWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-327-8600
Practice Address - Fax:201-327-8225
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60 245662207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery