Provider Demographics
NPI:1306074570
Name:MOONEY, JAMES P JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:MOONEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:P
Other - Last Name:MOONEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:352 TIMBERLANE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2845
Mailing Address - Country:US
Mailing Address - Phone:203-795-3986
Mailing Address - Fax:203-795-9849
Practice Address - Street 1:352 TIMBERLANE DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-2845
Practice Address - Country:US
Practice Address - Phone:203-795-3986
Practice Address - Fax:203-795-9849
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT84122083P0500X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM250000293Medicare PIN