Provider Demographics
NPI:1215985585
Name:MOORE, SEAN T (MPT)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:T
Last Name:MOORE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 SAINT JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:UNION BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-2816
Mailing Address - Country:US
Mailing Address - Phone:732-418-7033
Mailing Address - Fax:732-418-7011
Practice Address - Street 1:180 TICES LN
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1337
Practice Address - Country:US
Practice Address - Phone:732-418-7033
Practice Address - Fax:732-418-7011
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA01034900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7074461OtherAETNA PROVIDER ID
NJ204704751OtherTAX ID NUMBER
NJ7074461OtherAETNA PROVIDER ID
NJ070698QKJMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NJ204704751OtherTAX ID NUMBER
NJ102695Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NJ270001972OtherTAX ID NUMBER