Provider Demographics
NPI:1790329746
Name:MOISE, JOSEPH DURKHEIM (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DURKHEIM
Last Name:MOISE
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 BRUNSWICK AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4134
Mailing Address - Country:US
Mailing Address - Phone:908-986-6071
Mailing Address - Fax:
Practice Address - Street 1:2500 BRUNSWICK AVE STE 102
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4134
Practice Address - Country:US
Practice Address - Phone:908-986-6071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-02
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR353-P.A.363A00000X
NYF351735-01363LF0000X
NJ26NJ14950400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant