Provider Demographics
NPI:1194155747
Name:MOISE, CARL (ACCOUNTANT)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:MOISE
Suffix:
Gender:M
Credentials:ACCOUNTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 VIRGINIA CIR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-5151
Mailing Address - Country:US
Mailing Address - Phone:617-462-6733
Mailing Address - Fax:
Practice Address - Street 1:104 MARKET ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-6736
Practice Address - Country:US
Practice Address - Phone:617-462-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4220Medicaid
MA422014OtherMASSHEALTH
MA422014OtherMASSHEALTH
MA422017Medicare Oscar/Certification