Provider Demographics
NPI:1063882231
Name:MOORE, EDELMIRA APRIL (PA)
Entity type:Individual
Prefix:MRS
First Name:EDELMIRA
Middle Name:APRIL
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:EDELMIRA
Other - Middle Name:APRIL
Other - Last Name:TIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:99 HIGHWAY 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6423
Mailing Address - Country:US
Mailing Address - Phone:732-557-8000
Mailing Address - Fax:
Practice Address - Street 1:99 HIGHWAY 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6423
Practice Address - Country:US
Practice Address - Phone:202-460-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25 MP00378900363AM0700X
VA0110- 004962363AM0700X
NJ25MP00378900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical