Provider Demographics
NPI:1932633195
Name:MOVE, MICHELLE (MSED)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MOVE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2007
Mailing Address - Country:US
Mailing Address - Phone:917-558-2531
Mailing Address - Fax:
Practice Address - Street 1:2148 OCEAN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1406
Practice Address - Country:US
Practice Address - Phone:718-375-2505
Practice Address - Fax:718-375-2472
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NY1280115181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator