Provider Demographics
NPI:1457551442
Name:SUSAN I MORENO M.D. P.C.
Entity Type:Organization
Organization Name:SUSAN I MORENO M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-845-2323
Mailing Address - Street 1:196 GROVE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:THOROFARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08086
Mailing Address - Country:US
Mailing Address - Phone:856-845-2323
Mailing Address - Fax:856-845-4888
Practice Address - Street 1:196 GROVE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:THOROFARE
Practice Address - State:NJ
Practice Address - Zip Code:08086
Practice Address - Country:US
Practice Address - Phone:856-845-2323
Practice Address - Fax:856-845-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA05706900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0509463000OtherKEYSTONE, AMERI, BC/BS
2162090OtherAETNA
905513OtherFIRST HEALTH
1697844001OtherCIGNA
G22323OtherAMERI HEALTH ADMIN.
0558269000OtherAMERIIHEALTH PERSONAL CHO
722323OtherPABS PC
722323OtherAMERIHEALTH PC
P2681709OtherOXFORD HEALTH PLANS
722323OtherHORIZON BC/BS NJ
722323OtherHORIZON BC/BS NJ
905513OtherFIRST HEALTH