Provider Demographics
NPI:1912593997
Name:MOORHOUSE, ANDREW T (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:T
Last Name:MOORHOUSE
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 KRESSON GIBBSBORO RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-9567
Mailing Address - Country:US
Mailing Address - Phone:856-776-1385
Mailing Address - Fax:
Practice Address - Street 1:35 GREEN POND RD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-2052
Practice Address - Country:US
Practice Address - Phone:973-625-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00601700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant