Provider Demographics
NPI:1669734448
Name:MORAN, JESSICA LIZU
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LIZU
Last Name:MORAN
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 1:311 10TH ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-4111
Mailing Address - Country:US
Mailing Address - Phone:917-273-9273
Mailing Address - Fax:
Practice Address - Street 1:311 10TH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4111
Practice Address - Country:US
Practice Address - Phone:917-273-9273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator