Provider Demographics
NPI:1194880823
Name:MOAT, ROBERT G (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:MOAT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1414
Mailing Address - Country:US
Mailing Address - Phone:201-599-9595
Mailing Address - Fax:201-599-1424
Practice Address - Street 1:9 FOREST AVE
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1414
Practice Address - Country:US
Practice Address - Phone:201-599-9595
Practice Address - Fax:201-599-1424
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00245900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPA450153Medicare PIN